Positive proximal resection margins after resection for carcinoma of the oesophagus and stomach: effect on survival and symptom recurrence.
BACKGROUND
Our aim was to determine the frequency, survival and symptomatic local recurrence rate of patients with a positive proximal resection margin in a series of patients having a resection for carcinoma of the oesophagus or stomach.


METHODS
A retrospective study of pathology reports and case notes. Survival and data on local recurrence were obtained from the patient or general practitioner.


RESULTS
Ten (11.5%) of 87 patients having a gastric or oesophageal resection for carcinoma had a positive proximal resection margin. All 10 patients underwent a palliative resection for late-stage disease. Nine were dead at an average 8.3 months (range 2-20 months) post-resection and one patient remains alive at 9 months. Only one of these 10 patients had evidence of a local recurrence with recurrent dysphagia prior to death at 11 months.


CONCLUSIONS
A high incidence of a positive proximal resection margin was found. This occurred in patients who underwent a palliative resection for late-stage disease, most of whom died before local recurrence became a problem. For patients recognized as having late-stage disease, surgery for symptom palliation need not be aggressive (such as to include a thoracotomy) because achieving microscopic clearance is unlikely to affect the long-term outcome.
Gall
C A
CA
Department of Surgery, Flinders Medical Center, Bedford Park, Australia.
Rieger
N A
NA
Wattchow
D A
DA
D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005763:Gastroenterostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome