Positive circumferential resection margin in patients with operable oesophageal cancer: an independent prognostic factor for survival. A single institution experience. — The Association Specialists
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Positive circumferential resection margin in patients with operable oesophageal cancer: an independent prognostic factor for survival. A single institution experience. (276)

Ada Ng 1 , Richard JE Skipworth 1 , Ross Smith 1 , Steven Leibman 1 , Garett Smith 1
  1. Royal North Shore Hospital, St Leonards, NSW, Australia

BACKGROUND

There are conflicting opinions regarding the value of positive circumferential resection margin (CRM) as a prognostic factor in oesophageal cancer. Much controversy surrounds the definition of “positive circumferential margin”. The UK Royal College of Pathologists(RCP) define positive CRM as tumour cells seen within 1mm of resection margin, whereas the College of American Pathologists(CAP) define it as tumour found at the cut resection margin.

AIM

The aim of this study is to appraise the clinical prognostic value of microscopic CRM involvement and its impact on survival in a single institution.

METHODS

A retrospective analysis of a prospectively maintained database was performed. Clinical, operative and pathological data for patients undergoing oesophagectomy were reviewed.
Circumferential margins were divided into 3 groups: R0(uninvolved margin), RCP group(microscopic tumour cells at 0.1-1.0mm), CAP(microscopically involved margin).
Continuous data were compared using the Mann-Whitney U test, ordinal data with Fischer’s exact test. Survival was analysed by the Kaplan-Meier method with comparison made using the log-rank test. P<0.05 was considered significant


RESULTS

Between December 2001 and May 2012, 134 patients underwent surgical resection for primary malignancy of the oesophagus or OGJ. There were 113(84.3%) adenocarcinoma, 20(14.9%) SCC and 1(0.7%) undifferentiated large cell carcinoma. 95(70.9%) patients underwent neoadjuvant treatment. 106(79.1%) patients had R0 resections, 15(11.2%) in RCP group and 13(9.7%) in the CAP group. Neoadjuvant therapy did not affect the rate of R0 resection. Survival analysis showed that R0 patients had significantly improved survival compared to RCP and CAP. There was no difference in survival between RCP and CAP groups. Combining RCP and CAP into a single group (CRM positive), multivariate analysis shows CRM positivity to be an independent prognostic factor of survival (HR2.51; 95% 1.42-4.45;p=0.002).

CONCLUSION

In this series CRM positivity was an independent prognostic factor for survival. We could not demonstrate a survival difference between patients with margin positivity using either RCP or CAP definitions.