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Proximal Resection Margin in Ivor-Lewis Oesophagectomy for Cancer

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

Abstract

Objective

The purpose of this study was to investigate whether a long proximal oesophageal resection margin (PRM) is associated with improved survival after oesophagectomy for cancer and to identify the optimal margin to aim for in this patient group.

Methods

A prospectively maintained database identified 174 patients who underwent Ivor-Lewis oesophagectomy for cancer. Demographic, clinical, and pathological data were collected. X-tile software was used to identify the optimal resection point. Two models were analysed: single point resection with comparison of two groups (short and long), and two resection points with three groups (short, medium, and long) to provide a range.

Results

The median PRM was 4.0 cm (interquartile range: 2.5–6.0 cm). After adjustment for significant confounders, multivariable Cox PH analysis demonstrated that the optimal resection margin was 1.7 cm, and in the three-group analysis the optimum PRM was between 1.7 and 3 cm. In the two-group analysis, the long margin had no effect on DFS (p = 0.37), but carried a significantly improved overall survival (hazard ratio [HR] = 0.46, 95 % confidence interval [CI] 0.25–0.87, p = 0.02). In the three-group analysis, the medium and long groups had improved OS compared with the short group (on average 54 %, HR ≥ 0.45, p ≤ 0.04). The 5-year disease-free and overall survival rates were highest in the medium PRM group (48 and 57 % respectively).

Conclusions

Optimal survival following oesophagectomy for cancer is achieved with a PRM > 1.7 cm, but a PRM > 3 cm does not yield a further survival advantage. Thus, the optimal PRM is likely to be between 1.7 and 3 cm.

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Acknowledgment

The authors thank Kashfia Chowdhury for helping with the statistical analysis.

Contributions

YAQ and RCW collected clinical data. YAQ and S-J S wrote the manuscript. S-J S performed all the statistical analyses. SFH designed the study and edited the manuscript.

Disclosure

None declared.

Author information

Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, The Royal London Hospital, London, UK

    Y. A. Qureshi MBBS, MRCS, MSc, FRCS, R. C. Walker MBChB, MRCS & S. F. Hughes MS, FRCS

  2. Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK

    S.-J. Sarker MSc(Stat), MSc(Epid), PhD, PGCAP

Authors
  1. Y. A. Qureshi MBBS, MRCS, MSc, FRCS
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  2. S.-J. Sarker MSc(Stat), MSc(Epid), PhD, PGCAP
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  3. R. C. Walker MBChB, MRCS
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  4. S. F. Hughes MS, FRCS
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Correspondence to Y. A. Qureshi MBBS, MRCS, MSc, FRCS.

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Qureshi, Y.A., Sarker, SJ., Walker, R.C. et al. Proximal Resection Margin in Ivor-Lewis Oesophagectomy for Cancer. Ann Surg Oncol 24, 569–577 (2017). https://doi.org/10.1245/s10434-016-5510-y

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  • DOI: https://doi.org/10.1245/s10434-016-5510-y

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