Appropriate Proximal Resection Margin Distance for Esophagogastric Junction Adenocarcinoma

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Esophagogastric junction (EGJ) adenocarcinoma surgery requires careful consideration of proximal resection margins.
• Current guidelines lack consensus on optimal proximal margin distance, impacting patient outcomes.
• The prognostic significance of proximal margin distance in EGJ adenocarcinoma remains unclear.

Purpose of the Study:

• To determine the appropriate proximal resection margin distance for EGJ adenocarcinoma.
• To evaluate the impact of proximal margin distance on long-term survival outcomes.
• To provide evidence-based recommendations for surgical margins in EGJ adenocarcinoma.

Main Methods:

• Retrospective analysis of 109 patients with Siewert type II/III EGJ adenocarcinoma.
• Analysis of delta proximal margin (ΔPM and ΔPM') to account for gross and pathological margins, including fixation shrinkage.
• Stratification of margin recommendations by cancer stage and histology, with survival analysis.

Main Results:

• Recommended gross resection margins vary by stage and histology: ≥9 mm (early), ≥15 mm (advanced differentiated), ≥21 mm (advanced undifferentiated).
• Large tumor size (≥40 mm) correlated with increased margin discrepancy (p=0.028).
• Advanced EGJ adenocarcinoma patients with <15 mm gross margin had significantly worse relapse-free survival (p=0.038) and it was a significant prognostic factor (p=0.017).

Conclusions:

• A gross proximal margin of at least 15 mm is suggested to minimize positive margins.
• Achieving a ≥15 mm proximal margin may confer a survival advantage for advanced EGJ adenocarcinoma.
• This study provides critical data for optimizing surgical resection in EGJ adenocarcinoma.