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Impact of Circumferential Resection Margin Distance on Locoregional Recurrence and Survival after Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

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

Abstract

Background

Close circumferential resection margin (CRM) is an established predictor for locoregional recurrence (LR) in rectal cancer but remains controversial in esophageal malignancy. As yet, little is known about the significance of CRM after chemoradiotherapy (CRT), especially in squamous cell carcinoma (SCC). This study investigated the relationship between CRM distance and recurrence after neoadjuvant CRT in esophageal SCC patients.

Methods

Between 1997 and 2005, esophageal SCC patients who underwent surgery after neoadjuvant CRT and with pathology stage T3N0M0 and T3N1M0 (metastatic lymph nodes <2) were selected. CRM distance was reassessed and divided into three groups (group 1: CRM >1 mm, group 2: uninvolved CRM but <1 mm, group 3: CRM involved).

Results

The cohort comprised 145 male and 6 female patients with mean age of 57 years. There were 74, 51, and 26 patients in group 1, 2, and 3, respectively. With median follow-up period of 50 months, LR developed in 30.5% of patients. Both group 2 and group 3 had significantly higher LR than group 1 (37 and 42% vs. 21%, P < 0.05). Meanwhile, mean time from operation to recurrence was also significantly shorter in group 2 and group 3 than in group 1 (267 and 269 days versus 402 days, P < 0.05). Five-year disease-specific survival (DSS) was highest in group 1 (40%). Despite the similarity in LR, 5-year DSS significantly differed between group 2 and group 3 (22 vs. 7%, P < 0.05). The higher rate of distant recurrence (DR) and concomitant LR + DR in group 3 accounted for the survival difference.

Conclusion

In ypT3 esophageal SCC patients, CRM distance provides useful information for risk stratification in cancer recurrence and survival.

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Acknowledgment

This study was supported in part by grant NSC 98-2314-B-182A-036 from the National Science Council, Executive Yuan, and in part by grant NMRPG380041 form the Chang Gung Memorial Hospital, Taiwan, Republic of China.

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Authors and Affiliations

  1. Graduate Institute of Clinical Medical Sciences, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Yin-Kai Chao MD

  2. Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Yin-Kai Chao MD, Ming-Ju Hsieh MD & Yi-Cheng Wu MD

  3. Department of Pathology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Chi-Ju Yeh MD

  4. Division of Haematology/Oncology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Hsien-Kun Chang MD

  5. Department of Radiation Oncology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Chen-Kan Tseng MD

  6. Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Yin-Yi Chu MD

  7. Division of Thoracic Surgery, BENQ Medical Center, Jianye District, Nanjing, China

    Hui-Ping Liu MD

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  1. Yin-Kai Chao MD
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  2. Chi-Ju Yeh MD
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  8. Hui-Ping Liu MD
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Correspondence to Hui-Ping Liu MD.

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Chao, YK., Yeh, CJ., Chang, HK. et al. Impact of Circumferential Resection Margin Distance on Locoregional Recurrence and Survival after Chemoradiotherapy in Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 18, 529–534 (2011). https://doi.org/10.1245/s10434-010-1244-4

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  • DOI: https://doi.org/10.1245/s10434-010-1244-4

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