Effect of neoadjuvant chemotherapy on circumferential margin positivity and its impact on prognosis in patients with resectable oesophageal cancer

Background: The significance of circumferential resection margin (CRM) involvement in oesophageal cancer surgery is controversial. This study investigated the relationship between CRM involvement, locoregional recurrence and survival, after surgery alone or with neoadjuvant chemotherapy. Methods: Pa...

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Bibliographic Details
Published in:British journal of surgery 2008-02, Vol.95 (2), p.191-194
Main Authors: Sujendran, V., Wheeler, J., Baron, R., Warren, B. F., Maynard, N.
Format: Article
Language:English
Subjects:
Adenocarcinoma - drug therapy
Adenocarcinoma - mortality
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Biological and medical sciences
Carcinoma, Squamous Cell - drug therapy
Carcinoma, Squamous Cell - mortality
Carcinoma, Squamous Cell - surgery
Chemotherapy, Adjuvant
Cisplatin - administration & dosage
Disease-Free Survival
Esophageal Neoplasms - drug therapy
Esophageal Neoplasms - mortality
Esophageal Neoplasms - surgery
Esophagus
Female
Fluorouracil - administration & dosage
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Humans
Lymphatic Metastasis
Male
Medical sciences
Middle Aged
Neoadjuvant Therapy
Neoplasm Recurrence, Local - etiology
Neoplasm Recurrence, Local - mortality
Prospective Studies
Treatment Outcome
Tumors
Citations: Items that cite this one
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Summary:Background: The significance of circumferential resection margin (CRM) involvement in oesophageal cancer surgery is controversial. This study investigated the relationship between CRM involvement, locoregional recurrence and survival, after surgery alone or with neoadjuvant chemotherapy. Methods: Patients operated on by one surgeon at a tertiary referral centre between October 1997 and May 2004 were identified from a prospective database. Results: Some 242 patients underwent oesophagectomy; 91 had surgery alone, 142 had neoadjuvant chemotherapy and nine neoadjuvant chemoradiotherapy. Among patients with histologically confirmed T3 tumours, 26 (55 per cent) of 47 who underwent surgery alone had CRM involvement, compared with 27 (31 per cent) of 88 patients who completed two cycles of neoadjuvant chemotherapy (P = 0·005). Thirty‐seven (42 per cent) of 89 patients with a negative CRM developed locoregional recurrence, compared with 33 (59 per cent) of 56 with a positive margin (P = 0·032); median survival was 28 and 12 months respectively (P < 0·001). Cox multivariable regression analysis identified CRM involvement as an independent prognostic factor (P = 0·006). Conclusion: A positive CRM is an independent predictor of overall survival after oesophageal cancer resection. There has been a significant decrease in CRM involvement with the introduction of neoadjuvant chemotherapy. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Chemotherapy reduces risk of margin positivity
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.5983