Prognostic significance of circumferential resection margin involvement in patients receiving potentially curative treatment for oesophageal cancer

Quinn, Lauren; Hollis, Alexander Conor; Hodson, James; Elshafie, Mona; Hallissey, M. T.; Whiting, John; Griffiths, Ewen

doi:10.1016/j.ejso.2018.05.017

Cited by 10 publications

(12 citation statements)

References 40 publications

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“…Patients with inoperable disease undergoing ‘open and close’ procedures, with no resection, were excluded. The data set included demographic, treatment and pathology details along with complications. The study was approved by the Queen Elizabeth Hospital clinical audit department.…”

Section: Methodsmentioning

confidence: 99%

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

et al. 2020

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Background: Recent evidence suggests that complications after oesophagectomy may decrease shortand long-term survival of patients with oesophageal cancer. This study aimed to analyse the impact of complications on survival in a Western cohort. Methods: Complications after oesophagectomy were recorded for all patients operated on between January 2006 and February 2017, with severity defined using the Clavien-Dindo classification. Associations between complications and overall and recurrence-free survival were assessed using univariable and multivariable Cox regression models. Results: Of 430 patients, 292 (67⋅9 per cent) developed postoperative complications, with 128 (39⋅8 per cent) classified as Clavien-Dindo grade III or IV. No significant associations were detected between Clavien-Dindo grade and either tumour (T) (P = 0⋅071) or nodal (N) status (P = 0⋅882). There was a significant correlation between Clavien-Dindo grade and ASA fitness grade (P = 0⋅032). In multivariable analysis, overall survival in patients with Clavien-Dindo grade I complications was similar to that in patients with no complications (hazard ratio (HR) 0⋅97, P = 0⋅915). However, patients with grade II and IV complications had significantly shorter overall survival than those with no complications: HR 1⋅64 (P = 0⋅007) and 1⋅74 (P = 0⋅013) respectively. Conclusion: Increasing severity of complications after oesophagectomy was associated with decreased overall survival. Prevention of complications should improve survival.Funding information Queen Elizabeth Hospital Birmingham Charity (Upper Gastrointestinal Fund) Upper G.I. Blues of the consensus reporting guidelines on oesophageal complications 11 , a lack of standardization of complication reporting made understanding the relationship between complications and long-term survival difficult.

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Section: Methodsmentioning

confidence: 99%

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

et al. 2020

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“…Khan et al 21 Roh et al 22 Griffiths et al 23 Sujendran et al 24 Saha et al 27 Deeter et al 25 Scheepers et al 26 Sillah et al 28 Pultrum et al 30 Mirnezami et al 29 Chao et al 31 Verhage et al 32 Rao et al 34 0 Harvin et al 33 Reid et al 35 Theologou et al 14 O'Neill et al 37 Salih et al 36 Ahmad et al 38 O'Farrell et al 13 Lee et al 40 Okada et al 41 Ghadban et al 42 Quinn et al 15 Knight et al 44 Heterogeneity: τ 2 = 0•07; χ 2 = 82•97, 25 d.f., P < 0•001; I 2 = 70% Total Test for overall effect: Z = 8•06, P < 0•001…”

Section: Weight (%) H R H Rmentioning

confidence: 99%

“…Analysis of the 26 studies reporting univariable survival analyses, using the RCP definition, found OS to be shorter Deeter et al 25 Pultrum et al 30 Verhage et al 32 Chao et al 31 Ahmad et al 38 Salih et al 36 O'Farrell et al 13 O'Neill et al 37 Gilbert et al 39 Lee et al 40 Okada et al 41 Ghadban et al 42 Knight et al 44 Quinn et al 15 1 HR, hazard ratio.…”

Section: Meta-analysismentioning

confidence: 99%

“…Sujendran et al 24 Thompson et al 8 Saha et al 27 Scheepers et al 26 Mirnezami et al 29 Reid et al 35 Ahmad et al 38 Theologou et al 14 Okada et al 41 Depypere et al 43 Knight et al 44 Quinn et al 15 An inverse-variance random-effects model was used for meta-analysis. Hazard ratios (HRs) are shown with 95 per cent confidence intervals.…”

Section: No Adjuvant Therapy 2mentioning

confidence: 99%

“…CRM−/+, negative/positive circumferential resection margin; RCP, Royal College of Pathologists. Verhage et al 32 Ahmad et al 38 Gilbert et al 39 Okada et al 41 Depypere et al 43 Knight et al 44 Quinn et al 15 Test for overall effect: Z = 4•30, P < 0•001…”

Section: No Adjuvant Therapy 2mentioning

confidence: 99%

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Meta‐analysis of the influence of a positive circumferential resection margin in oesophageal cancer

et al. 2019

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BackgroundThe evidence regarding the prognostic impact of a positive circumferential resection margin (CRM) in oesophageal cancer is conflicting, and there is global variability in the definition of a positive CRM. The aim of this study was to determine the impact of a positive CRM on survival in patients undergoing oesophagectomy for oesophageal cancer.MethodsA systematic review and meta‐analysis was performed. PubMed and Embase databases were searched for articles to May 2018 examining the effect of a positive CRM on survival. Cohort studies written in English were included. Meta‐analyses of univariable and multivariable hazard ratios (HRs) were performed using both Royal College of Pathologists (RCP) and College of American Pathologists (CAP) criteria. Risk of bias was assessed using the Newcastle–Ottawa Scale. Egger regression, and Duval and Tweedie trim‐and‐fill statistics were used to assess publication bias.ResultsOf 133 studies screened, 29 incorporating 6142 patients were finally included for analysis. Pooled univariable HRs for overall survival in patients with a positive CRM were 1·68 (95 per cent c.i. 1·48 to 1·91; P < 0·001) and 2·18 (1·84 to 2·60; P < 0·001) using RCP and CAP criteria respectively. Subgroup analyses demonstrated similar results for patients by T category, neoadjuvant therapy and tumour type. Pooled HRs from multivariable analyses suggested that a positive CRM was independently predictive of a worse overall survival (RCP: 1·41, 1·21 to 1·64, P < 0·001; CAP: 2·37, 1·60 to 3·51, P < 0·001).ConclusionA positive CRM is associated with a worse prognosis regardless of classification system, T category, tumour type or neoadjuvant therapy.

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Raman spectroscopy for rapid intra-operative margin analysis of surgically excised tumour specimens

Hubbard

Shore

Stone

2019

Analyst

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Prognostic significance of circumferential resection margin involvement in patients receiving potentially curative treatment for oesophageal cancer

Abstract: CRM-involvement was not found to be independently predictive of prognosis, after accounting for other prognostic markers. As such, CRM should not be considered a major prognostic factor in patients with oesophageal cancer.

Cited by 10 publications

References 40 publications

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

Meta‐analysis of the influence of a positive circumferential resection margin in oesophageal cancer

Raman spectroscopy for rapid intra-operative margin analysis of surgically excised tumour specimens

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