Lateral resection margin and prognosis following R0 resection for oesophageal carcinoma. BJS 1999; 86: 424-424.
Published: 2nd January 2003
Authors: S. P. L. Dexter, N. Mapstone, I. G. Martin
For patients with rectal carcinoma, the finding of tumour within 1 mm of the circumferential resection margin is of independent prognostic importance. For patients undergoing oesophageal resection the significance of finding tumour within 1 mm of the lateral margin has not been described prospectively.
A series of 68 patients undergoing radical R0 oesophagectomy for carcinoma (46 adenocarcinomas) was studied prospectively. The resection specimens were examined prospectively by one pathologist and staged using the 1987 tumour node metastasis (TNM) classification. In addition, specimens in which tumour cells were seen within 1 mm of the lateral margin were regarded as being circumferential margin (CRM) positive. Survival was calculated using the Kaplan–Meier method and the Cox hazard model was used to identify independent effects on survival.
The overall 3‐year survival rate was 30 per cent (56 per cent stage I, 42 per cent stage II and 19 per cent stage III; P < 0·04). Although for patients with the CRM involved (n = 38) the survival rate was 20 per cent compared with 40 per cent in those in whom tumour was more than 1 mm from the lateral margin (P = 0·15), using Cox's proportional hazards model the effect of CRM involvement was not independent of the TNM stage.
The impact of CRM involvement in oesophageal cancer may be less marked than for rectal carcinoma. A larger study is needed to quantify the true importance of CRM involvement, particularly with the increasing use of neoadjuvant therapies. © 1999 British Journal of Surgery Society LtdFull text