Abstract
Esophagectomy (R0) remains the gold standard for the management of esophageal cancer. But due to close vicinity of esophagus with the major structures like heart, aorta, vertebral column, tracheobronchial tree and lungs, a wider circumferential resection is generally not possible and a R1/ R2 resection might occur. Therefore, locoregional recurrence rates of esophageal cancer are reported to be as high as 52%. The Royal College of Pathologists (RCP) and The College of American Pathologists (CAP) define circumferential resection margin (CRM) differently. A mean overall CRM involvement was found to be 40.7% (RCP criteria) and 11.8% (CAP criteria). Twometa-analyses have shown poor survival in CRM positive cases. CRM positivity in T1/ T2 lesions should not occur unless there is a surgical fault. For T3 lesions, a higher rate of CRM positivity has been documented. Therefore, a wider CRM using transthoracic approach appears mandatory, especially for T3 lesions.
Highlights
Esophageal cancer is one of aggressive cancers with an increasing incidence worldwide.[1,2] There has been persistently improvement in diagnostic and therapeutic modalities which have reduced the morbidity and postoperative mortality.[3] cancer are reported to be as high as 52%.6,7 Histologic characteristics like depth of tumor invasion, lymph node involvement, and proximal and distal resection margins are accepted risk factors for patients’ survival and tumor recurrence[8,9,10], while the role of circumferential resection margin (CRM) is still debatable in the literature.Usual treatment protocols include preoperative chemoradiation for squamous cell carcinoma and perioperative chemotherapy for adenocarcinoma
Positive circumferential resection margin was associated with worse survival in patients with T3 stage disease according to the Royal College of Pathologists (RCP) (HR, 1.381; 95% CI, 1.028–1.584; p
Positive circumferential resection margin was associated with worse survival in patients receiving neoadjuvant therapy according to the RCP (HR, 1.676; 95% CI, 1.023–2.744; p = 0.04) and CAP (HR, 1.847; 95% CI, 1.226–2.78; p = 0.003) criteria, respectively
Summary
Esophageal cancer is one of aggressive cancers with an increasing incidence worldwide.[1,2] There has been persistently improvement in diagnostic and therapeutic modalities which have reduced the morbidity and postoperative mortality.[3] cancer are reported to be as high as 52%.6,7 Histologic characteristics like depth of tumor invasion, lymph node involvement, and proximal and distal resection margins are accepted risk factors for patients’ survival and tumor recurrence[8,9,10], while the role of circumferential resection margin (CRM) is still debatable in the literature. Positive circumferential resection margin was associated with worse survival in patients receiving neoadjuvant therapy according to the RCP (HR, 1.676; 95% CI, 1.023–2.744; p = 0.04) and CAP (HR, 1.847; 95% CI, 1.226–2.78; p = 0.003) criteria, respectively. When applying RCP criteria, the difference did not remain significant (p = 0.086).[29] Scheepers et al.[41] further divided transhiatal esophageal resections into a laproscopic and an open group They were not able to detect any significant differences in regards to CRM involvement (p = 0.192).[41] Pultrum et al.[42] could not find an association between type of surgery and CRM (p = 0.693).[42]
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