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

Abstract

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.

Incidence and Predictors of Textbook Outcome after Minimally Invasive Esophagectomy for Cancer: A Two-Center Study

“…Upon examining the impacts of these surgical techniques on the criteria defining TBO, it was observed that patients undergoing RE experienced fewer major complications than those treated with VATE. More critically, RE was associated with a higher likelihood of achieving margin-negative resections and an increased count of harvested lymph nodes—two factors that are known to correlate with a more favorable prognosis [ 30 , 31 , 32 , 33 ]. Taken together, these findings suggest that RE not only potentially eases postoperative recovery, but also contributes to superior oncological outcomes.…”

Clinicopathological Characteristics and Survival Outcomes in Patients with Advanced Esophageal Squamous Cell Carcinoma Who Were Intraoperatively Diagnosed Non-Curative

“…Postoperative prognosis is highly dependent on the extent of locoregional tumor clearance in addition to pathological stage, particularly LN spread [13,26,27]. Previous studies showed that the median survival of non-curative esophagogastric cancer was 5.1 months [28] and 1-and 3-year OS rates of patients with cT4 for palliative resections (R1/2) were 8.5% and 0%, respectively [29].…”

“…However, curative esophagectomy is not always possible due to invasion of adjacent organs, intraoperative distant metastases, or positive resection margins [12,13]. A previous study using the Netherlands Cancer Registry showed that failure-to-cure was noted in 15% of surgically treated patients, and the most common reason for non-curative resection is an invasion into adjacent organs (T4b) [14].…”