Shrinkage of the esophagus after resection for carcinoma

The purpose of this study was to document and quantitate the degree of shrinkage of resection margins of the esophagus following extirpation for carcinoma. Measurements were made at operation before the esophagus was removed (in-situ), when the removed specimen had been stretched maximally (stretched), with the specimen lying free (contracted), and after fixation (fixed). After resection, there was substantial shrinkage of the margins, and the upper margins underwent a greater degree of shrinkage than the lower margins, with the tumor changing little in length. In the contracted state before fixation, the upper and lower margins were reduced to 44% and 54% of their in-situ lengths, respectively; after fixation, they were 32% and 39%, respectively. Even after maximal stretching, only 73% of the upper and 89% of the lower in-situ resection margins were restored. The overall shrinkage for the whole specimen after fixation was 50%. It is concluded that there is considerable shrinkage of the resection margins in the esophagus from the time of operation to fixation, and this accounts for the discrepancy claimed by surgeons and pathologists regarding the length of the margins. This finding has relevance in the extrapolation of surgical resection margins from pathological specimens.