Margin involvement and outcome in oesophageal carcinoma: a 10-year experience in a specialist unit

Mulligan, E.; Dunne, Barbara; Griffin, Michael J.; Keeling, N; Reynolds, John V.

doi:10.1016/j.ejso.2003.11.009

Cited by 41 publications

(37 citation statements)

References 14 publications

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“…Mulligan et al [42] demonstrated in their study that multimodal therapy including neoadjuvant treatment decreases margin involvement and as such significantly improves patients' prognosis. In addition, even patients with involved margin yielded decreased recurrence rate following a multimodal treatment [42]. The advantage of neoadjuvant therapy was recently proven by the CROSS trial [43].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the risk of morbidity and mortality by neoadjuvant therapy should not be taken lightly [41]. Mulligan et al [42] demonstrated in their study that multimodal therapy including neoadjuvant treatment decreases margin involvement and as such significantly improves patients' prognosis. In addition, even patients with involved margin yielded decreased recurrence rate following a multimodal treatment [42].…”

Section: Discussionmentioning

confidence: 99%

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Does the Margin Matter in Esophageal Cancer

Karstens

Izbicki²,

Reeh³

2017

Dig Surg

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Background: The prognostic impact of circumferential resection margin (CRM) involvement in resected esophageal cancer (EC) is controversial discussed. The College of American Pathologists (CAP) and the Royal College of Pathologists (RCP) provide 2 different definitions of CRM involvement. The aim of this systematic review was to evaluate the clinical significance of CRM involvement on patients' survival following esophagectomy due to EC. Methods: PubMed, Science Direct, and Google scholar were searched for studies analyzing the clinical impact of CRM in EC. Summary: A total of 28 studies analyzed the prognostic effect of a positive CRM in EC. A wide range of CRM involvement (8.6-83.1%) was reported. Both available meta-analyses found a significant association between a positive CRM and patients' survival irrespective of RCP (OR 2.52 [95% CI 1.96-3.25; p < 0.001]) or CAP (OR 4.02 [95% CI 2.25-7.20; p < 0.001]) criteria. The influence of neoadjuvant therapy on the CRM remains unclear. Key Messages: CRM involvement is a useful parameter for EC patients' prognosis. The application of CAP criteria should be preferred since patients with a poor prognosis can be identified more sufficiently. Neoadjuvant therapy and en bloc transthoracic esophagectomy show favorable results for achievement of negative CRM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does the Margin Matter in Esophageal Cancer

Karstens

Izbicki²,

Reeh³

2017

Dig Surg

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“…Presence of tumour within 1 mm of this resection margin is classified as evidence of involvement. Although it has long been established that involvement of the proximal or distal resection margin is a poor prognostic factor [46,47], the relevance of the CRM status has been unclear and few studies have addressed this issue. However, the increased awareness of the CRM status in rectal cancer has inspired investigation in oesophageal cancer.…”

Section: Introductionmentioning

confidence: 99%

Emerging aspects of oesophageal and gastro-oesophageal junction cancer histopathology – an update for the surgical oncologist

et al. 2006

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Adenocarcinoma of the oesophagus and gastro-oesophageal junction are rapidly increasing in incidence and have a well described sequence of carcinogenesis: the Barrett's metaplasia-dysplasiaadenocarcinoma sequence. During recent years there have been changes in the knowledge surrounding disease progression, cancer management and histopathology specimen reporting. Tumours around the gastro-oesophageal junction (GOJ) pose several specific challenges. Numerous difficulties arise when the existing TNM staging systems for gastric and oesophageal cancers are applied to GOJ tumours. The issues facing the current TNM staging and GOJ tumour classification systems are reviewed in this article. Recent evidence regarding the importance of several histopathologically derived prognostic factors, such as circumferential resection margin status and lymph node metastases, have implications for specimen reporting. With the rising use of multimodal treatments for oesophageal cancer it is important that the response of the tumour to this therapy is carefully documented pathologically. In addition, several controversial and novel areas such as endoscopic mucosal resection, lymph node micrometastases and the sentinel node concept are being studied. We aim to review these aspects, with special relevance to oesophageal and gastro-oesophageal cancer specimen reporting, to update the surgical oncologist with an interest in upper gastrointestinal cancer.

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“…A similar influence on prognosis is seen in esophageal cancer. 15,17 Several studies have already demonstrated that a negative CRM (CRM -) is associated with improved survival. 7,8,10,20,24 However, the definition of a tumor positive CRM (CRM + ) remains unclear.…”

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confidence: 99%

How to Define a Positive Circumferential Resection Margin in T3 Adenocarcinoma of the Esophagus

Verhage¹,

Zandvoort²,

Kate

et al. 2011

American Journal of Surgical Pathology

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A positive circumferential resection margin (CRM) is associated with poor survival after esophagectomy for cancer. The Royal College of Pathologists (RCP) defines a CRM when tumor is found <1 mm of the lateral margin whereas the College of American Pathologists (CAP) defines CRM when tumor cells are located at the lateral margin. This study evaluates the clinical prognostic significance of CRM on overall survival (OS) and disease-free survival (DFS) in patients who underwent esophagectomy for T3 esophageal adenocarcinoma. Analysis included 132 patients. CRM was found in 26 cases (19.7%) corresponding to CAP criteria versus 89 cases (67.4%) corresponding to RCP criteria. Median OS using RCP criteria was 16.4 (95%CI, 8.5-24.2) months for CRM patients versus 21.0 (95%CI 16.3-25.6) months in CRM patients (P=0.144). With CAP criteria, median OS in CRM and CRM patients was 9.4 (95%CI, 7.6-11.2) months versus 21.6 (95%CI, 18.9-24.3) months, respectively (P=0.000). Median DFS using RCP criteria was 18.0 (95%CI, 11.5-24.6) months for CRM patients versus 11.0 (95%CI, 8.1-14.0) months for CRM patients (P=0.257). Applying the CAP criteria, median DFS in CRM and CRM patients was 16.3 (95%CI, 10.6-22.0) months versus 7.0 (95%CI, 6.3-7.8) months, respectively (P=0.000). Effects of a CRM according to CAP criteria remained significant after multivariate testing [OS: hazard ratio (HR), 2.43; 95%CI, 1.52-3.90; DFS: HR, 2.09; 95%CI, 1.32-3.30]. Only with the CAP criteria, CRM is an independent prognostic factor for survival and recurrence in patients with T3 adenocarcinoma of the esophagus. The circumferential margin should only be considered positive (ie, R1) if the tumor is found at the inked lateral margin of resection in accordance with the CAP criteria.

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Margin involvement and outcome in oesophageal carcinoma: a 10-year experience in a specialist unit

Cited by 41 publications

References 14 publications

Does the Margin Matter in Esophageal Cancer

Does the Margin Matter in Esophageal Cancer

Emerging aspects of oesophageal and gastro-oesophageal junction cancer histopathology – an update for the surgical oncologist

How to Define a Positive Circumferential Resection Margin in T3 Adenocarcinoma of the Esophagus

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