Does the Margin Matter in Esophageal Cancer

Karstens, Karl-Frederick; Izbicki, Jakob R.; Reeh, Matthias

doi:10.1159/000478669

Cited by 14 publications

(10 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One explanation for this discrepancy result may be the heterogeneity of the studies. The patients with mixed different T stage, various preoperative therapy (with or without neoadjuvant treatment), and inconsistent tumor node metastasis (TNM) classification version (5) contributed to the conflict results. In order to make further exploration of the exclusive role of CRM on ESCC patients, we only included the patients at pT3N0M0 stage and without receiving neoadjuvant radiochemotherapy in this study.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of circumferential resection margin in T3N0M0 esophageal squamous cell carcinoma

et al. 2018

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Prognostic value of circumferential resection margin in T3N0M0 esophageal squamous cell carcinoma

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The R1 resection rate, generally reported to be in the range 8–19 per cent 4 , 11 , 12 , was 9.7 per cent in the present study, bearing in mind that this is affected by the classification system used and how meticulously margins are investigated 7 . The circumferential margin was most commonly involved, affecting 7.8 per cent of specimens; this is in the lower range of previous publications based on CAP criteria 7 .…”

Section: Discussionmentioning

confidence: 44%

“…Many studies looking at the influence of R status have been small 7 and definitions of R1 resection rely on two different systems. The UK Royal College of Pathologists 8 definition includes resections with tumour cells identified within 1 mm of a margin as R1, whereas the College of American Pathologists (CAP) 9 requires tumour cells to be present at a margin.…”

Section: Introductionmentioning

confidence: 99%

Outcome of microscopically non-radical oesophagectomy for oesophageal and oesophagogastric junctional cancer: nationwide cohort study

et al. 2021

View full text Add to dashboard Cite

Background Microscopically non-radical (R1) oesophageal cancer resection has been associated with worse survival. The aim of this study was to identify risk factors for R1 resection and to investigate how this affects long-term survival. Methods The Swedish National Register for Oesophageal and Gastric Cancer was used to identify all patients who underwent oesophageal cancer resection with curative intent between 2006 and 2017. Risk factors for R1 resection were assessed by multivariable logistic regression analysis, and factors predicting 5-year survival identified by multivariable Cox regression. Results The study included 1460 patients. Surgical margins were involved microscopically in 142 patients (9.7 per cent). The circumferential resection margin was involved in 114 (7.8 per cent), the proximal margin in 53 (3.6 per cent), and the distal margin in 29 (2.0 per cent). In 30 specimens (2.1 per cent), two or all three margins were involved. Independent risk factors for R1 resection were male sex, low BMI, absence of neoadjuvant treatments, and clinical T4 disease. The 5-year survival rate for the entire cohort was 42.2 per cent, but only 18.0 per cent for those who had an R1 resection. Independent risk factors for death within 5 years of resection were male sex, age above 60 years, normal BMI, ASA fitness grade III, intermediate-level education, R1 resection (hazard ratio 1.80, 95 per cent c.i. 1.40 to 2.32), clinical T3 disease, and clinical lymph node metastasis. Conclusion R1 resection is common and predicts poor 5-year survival. Absence of neoadjuvant treatment is a risk factor for R1 resection.

show abstract

“…Several authors suggest that R status should be considered not as an independent prognosticator, but rather as part of a wider panel of unfavorable tumor biology markers such as lymphovascular invasion and depth of tumor infiltration. [7][8][9] Currently, two different definitions of the R status are used in clinical practice. The Royal College of Pathologists (RCP) uses a more ''strict'' definition, considering R1 status as a clearance of \ 0.1 cm, 10 whereas the College of American Pathologists (CAP) defines a positive margin (R1) as a direct contact between the tumor and the surgical margin (clearance of 0.0 cm).…”

mentioning

confidence: 99%

The “Real R0”: A Resection Margin Smaller Than 0.1 cm is Associated with a Poor Prognosis After Oncologic Esophagectomy

et al. 2021

View full text Add to dashboard Cite

Background Although resection margin (R) status is a widely used prognostic factor after esophagectomy, the definition of positive margins (R1) is not universal. The Royal College of Pathologists considers R1 resection to be a distance less than 0.1 cm, whereas the College of American Pathologists considers it to be a distance of 0.0 cm. This study assessed the predictive value of R status after oncologic esophagectomy, comparing survival and recurrence among patients with R0 resection (> 0.1-cm clearance), R0+ resection (≤ 0.1-cm clearance), and R1 resection (0.0-cm clearance). Methods The study enrolled all eligible patients undergoing curative oncologic esophagectomy between 2012 and 2018. Clinicopathologic features, survival, and recurrence were compared for R0, R0+, and R1 patients. Categorical variables were compared with the chi-square or Fisher’s test, and continuous variables were compared with the analysis of variance (ANOVA) test, whereas the Kaplan-Meier method and Cox regression were used for survival analysis. Results Among the 160 patients included in this study, 113 resections (70.6%) were R0, 34 (21.3%) were R0+, and 13 (8.1%) were R1. The R0 patients had a better overall survival (OS) and disease-free survival (DFS) than the R0+ and R1 patients. The R0+ resection offered a lower long-term recurrence risk than the R1 resection, and the R status was independently associated with DFS, but not OS, in the multivariate analysis. Both the R0+ and R1 patients had significantly more adverse histologic features (lymphovascular and perineural invasion) than the R0 patients and experienced more distant and locoregional recurrence. Conclusions Although R status is an independent predictor of DFS after oncologic esophagectomy, the < 0.1-cm definition for R1 resection seems more appropriate than the 0.0-cm definition as an indicator of poor tumor biology, long-term recurrence, and survival.

show abstract

Does the Margin Matter in Esophageal Cancer

Cited by 14 publications

References 46 publications

Prognostic value of circumferential resection margin in T3N0M0 esophageal squamous cell carcinoma

Prognostic value of circumferential resection margin in T3N0M0 esophageal squamous cell carcinoma

Outcome of microscopically non-radical oesophagectomy for oesophageal and oesophagogastric junctional cancer: nationwide cohort study

The “Real R0”: A Resection Margin Smaller Than 0.1 cm is Associated with a Poor Prognosis After Oncologic Esophagectomy

Contact Info

Product

Resources

About