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Significant Variation of Resected Meso-esophageal Tissue Volume in Two-Stage Subtotal Esophagectomy Specimens: A Retrospective Morphometric Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Differences in the extent and quality of surgical resection for esophageal cancer may influence the pathological staging and patient outcome. There are no data in the literature qualitatively and/or quantitatively characterizing esophagectomy specimens.

Methods

Macroscopic images of 161 esophagectomy specimens were analyzed retrospectively. The extent of resection was qualitatively classified as “muscularis propria,” “intra-meso-esophageal,” or “meso-esophageal.” The volume of meso-esophageal tissue was quantified morphometrically. The number of muscle defects per specimen was counted. Results were related to clinicopathological variables, including survival.

Results

Sixty-two (39 %) specimens were classified as “muscularis propria,” 65 (40 %) as “intra-meso-esophageal,” and 34 (21 %) as “meso-esophageal.” The morphometrically measured meso-esophageal tissue volume was different between the three types (P < 0.001). The specimen type was related to the total number of lymph nodes (P = 0.02), number of metastatic lymph nodes (P = 0.024), and depth of tumor invasion (P = 0.013), but not related to extramural tumor volume, circumferential resection margin status, or the surgeon performing the resection. The number of muscle defects per specimen was similar in all resection types. The resection specimen classification was related to survival in patients treated by surgery alone (P = 0.027).

Conclusions

This is the first study to quantify and classify the volume of tissue resected during esophagectomy. Our study shows significant variation of the resected tissue volume impacting pathological tumor staging. This variation was not associated with individual surgeon performance. A prospective, multicenter study is needed to validate our results and to investigate the potential biological mechanisms influencing the resectable volume of meso-esophageal tissue in cancer patients.

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Acknowledgment

The authors thank Steve Toms and Michael Todd from the Audiovisual Services, Department of Histopathology, St. James University Hospital, Leeds, UK, for taking and archiving the digital photographs used in this study as part of the routine specimen work-up. We would like to thank the surgeons from the Upper Gastrointestinal Surgery Unit (Mr HM Sue-Ling, Mr SPL Dexter and Mr AI Sarela) and the histopathologists from the Department of Histopathology, St. James’s Institute of Oncology, Leeds Teaching Hospitals NHS Trust, for their contributions.

Conflict of Interest

None of the authors has any commercial interests to disclose

FUNDING

This study did not receive any external funding.

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Authors and Affiliations

  1. Pathology & Tumour Biology, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK

    Amy S. Izon BSc (Hons.), Paul Jose MS & Heike I. Grabsch MD, PhD

  2. Department of Upper Gastrointestinal Surgery, St. James’s Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Paul Jose MS & Jeremy D. Hayden MD

Authors
  1. Amy S. Izon BSc (Hons.)
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  2. Paul Jose MS
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  3. Jeremy D. Hayden MD
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  4. Heike I. Grabsch MD, PhD
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Corresponding author

Correspondence to Heike I. Grabsch MD, PhD.

Additional information

Amy S. Izon and Paul Jose contributed equally to the manuscript.

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Izon, A.S., Jose, P., Hayden, J.D. et al. Significant Variation of Resected Meso-esophageal Tissue Volume in Two-Stage Subtotal Esophagectomy Specimens: A Retrospective Morphometric Study. Ann Surg Oncol 20, 788–797 (2013). https://doi.org/10.1245/s10434-012-2659-x

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  • DOI: https://doi.org/10.1245/s10434-012-2659-x

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