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Proximal Resection Margin in Ivor-Lewis Oesophagectomy for Cancer
Y A Qureshi1, S-J Sarker2, R C Walker3
1Department of Upper Gastrointestinal Surgery, The Royal London Hospital, London, UK. yassarqureshi@hotmail.co.uk.
Annals of Surgical Oncology
|August 31, 2016
Summary
Achieving a proximal oesophageal resection margin (PRM) greater than 1.7 cm improves survival after oesophagectomy for cancer. However, margins exceeding 3 cm offer no additional survival benefit, suggesting an optimal PRM range for improved patient outcomes.
Area of Science:
- Oncology
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Oesophageal cancer surgery requires careful consideration of resection margins to optimize patient survival.
- The impact of proximal oesophageal resection margin (PRM) length on survival after oesophagectomy is not fully established.
- Determining the optimal PRM is crucial for improving outcomes in patients undergoing oesophagectomy for cancer.
Purpose of the Study:
- To investigate the association between a long proximal oesophageal resection margin (PRM) and survival after oesophagectomy for cancer.
- To identify the optimal PRM to maximize survival rates in patients undergoing oesophagectomy.
- To evaluate the impact of different PRM lengths on disease-free survival (DFS) and overall survival (OS).
Main Methods:
- A prospectively maintained database of 174 patients who underwent Ivor-Lewis oesophagectomy for cancer was analyzed.
- Demographic, clinical, and pathological data were collected for all patients.
- X-tile software was used to determine optimal resection points, with analyses conducted using single-point (short vs. long) and two-point (short, medium, long) models.
Main Results:
- The median PRM was 4.0 cm. Multivariable analysis identified 1.7 cm as an optimal resection margin.
- In a three-group analysis, PRMs between 1.7 cm and 3 cm were associated with improved overall survival compared to shorter margins.
- While a PRM > 1.7 cm improved overall survival, margins > 3 cm did not confer further benefit; 5-year survival rates were highest in the medium PRM group (48% DFS, 57% OS).
Conclusions:
- An optimal proximal oesophageal resection margin (PRM) greater than 1.7 cm is associated with improved survival after oesophagectomy for cancer.
- A PRM exceeding 3 cm does not provide additional survival advantages.
- The optimal PRM for oesophageal cancer surgery is likely between 1.7 cm and 3 cm, balancing oncological clearance with maximal survival benefit.
