Analysis of Esophagectomy Margin Practice and Survival Implications

Area of Science:

• Surgical Oncology
• Thoracic Surgery
• Gastrointestinal Oncology

Background:

• Intraoperative positive margins during esophagectomy pose a challenge in esophageal cancer management.
• The impact of managing these positive margins on patient survival is crucial.

Purpose of the Study:

• To investigate how thoracic surgeons manage intraoperative positive margins during esophagectomy.
• To determine the relationship between margin status and survival outcomes in esophageal cancer.

Main Methods:

• A survey was distributed to thoracic surgeons regarding their management of positive margins.
• Retrospective analysis of a database from two high-volume centers (1994-2017) for patients with intraoperative positive margins.
• Overall survival (OS) and progression-free survival (PFS) were analyzed using Cox models.

Main Results:

• 85% of surveyed surgeons utilize frozen section analysis during esophagectomy.
• Of 94 patients with positive margins, 67 underwent re-resection, achieving R0 status in 44 (46.8%).
• R0 resection was associated with improved OS (13 vs. 3.4 months) and PFS (8.6 vs. 2.2 months). Margin status was an independent predictor of PFS.

Conclusions:

• Intraoperative frozen section analysis is widely used by thoracic surgeons to guide esophagectomy.
• Re-resection to achieve negative margins (R0) in esophageal cancer patients with initially positive margins improves progression-free survival.
• Final margin status is a significant prognostic factor for progression-free survival in esophageal cancer.