Introduction The TNM 7 classification system for oesophageal cancer defines circumferential resection margin (CRM) involvement as R0 (>1 mm), R1a (<1 mm), and R1b (involved margin). The prognostic importance of CRM involvement is unclear with previous studies demonstrating conflicting results. We evaluated survival according to CRM status for patients with locally advanced oesophageal adenocarcinoma who had neoadjuvant chemotherapy prior to Ivor Lewis en bloc oesophagectomy with extended lymphadenectomy.
Methods Since 2006, the CRM has been classified as R1a, R1b or R0, assessed by two specialist upper gastrointestinal pathologists in our unit. Since 2007, NAC prior to oesophagectomy was introduced as standard practice in patients with locally advanced oesophageal adenocarcinoma. A retrospective review of prospectively collected data were performed on all patients who underwent oesophagectomy for oesophageal and gastroesophageal junctional adenocarcinoma including demographic data, NAC, final histology, 30, 60, 90 and in-hospital mortality, and survival. Patients with proximal and distal resection margin involvement were excluded. The primary outcome was overall survival evaluated by Kaplan–Meier survival analysis.
Results 63 consecutive resections were included. 62% (n=39) were R0, 25% (n=16) were R1a and 13% (n=8) were R1b. 2-year overall survival was 56%, 63% and 13% respectively, with a statistically significant reduction in survival between R1b and R1a/R0 (p<0.05). Local recurrence rates were similar for R0 (8%), R1a (19%) and R1b (13%). The rate of distant metastases was higher in R1b (75%) compared to R0 (19%) and R1a (20.5%). Univariate analysis demonstrated that poor survival was associated with R1b but not R1a or R0.
Conclusion R1a and R0 CRM are associated with equivalent recurrence (local and distant) and survival rates to R0 in patients with oesophageal and GOJ adenocarcinoma following NAC and oesophagectomy. R1a CRM involvement does not adversely survival in patients with oesophageal and GOJ adenocarcinoma following NAC.
Competing interests None declared.
References 1. Pultrum B, et al. A critical appraisal of circumferential resection margins in esophageal carcinoma. Ann Surg Oncol 2010;17:812–20.
2. Sujendran V, et al. Effect of neoadjuvant chemotherapy on circumferential margin positivity and its impact on prognosis in patients with resectable oesophageal cancer. Br J Surg 2008;95:191–4.
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