What is the optimal distal resection margin for esophageal carcinoma?
BACKGROUND
Whereas a proximal resection margin of 12 cm is recommended for complete resection of esophageal cancer, the extent of distal resection is unclear.


METHODS
We examined distal resection margins in a consecutive series of patients who underwent esophagectomy for squamous cell carcinomas (n = 50), primary esophageal adenocarcinomas (n = 100), and adenocarcinomas of the cardia (n = 39), in whom all macroscopic tumor was judged to be completely resected.


RESULTS
Microscopic tumor was found at a 3-cm distal resection margin for one multifocal squamous cell carcinoma. Positive distal resection margins were seen in 12% (12 of 100 patients) of primary esophageal adenocarcinomas (median, 2 cm versus 4 cm if negative; p = 0.002, Wilcoxon) and 28% (11 of 39 patients) of cardia adenocarcinomas (median, 1 cm versus 3 cm if negative; p = 0.02, Wilcoxon). Although pathologic stage was shown to be the only significant predictor of overall survival (Hazard ratio [HR] 1.8; 95% confidence interval 1.2 to 2.6; p = 0.007), there was a trend toward reduced postoperative survival for patients with histologically positive distal resection margins, in particular for patients with cardia adenocarcinomas (median, 15.4 months versus 5.7 months if negative; p = 0.0001).


CONCLUSIONS
To achieve consistently negative distal resection margins, we recommend resection of at least 5 cm of macroscopically normal foregut below the distal margin of the primary tumor.
Casson
A G
AG
Regional Department of Thoracic Surgery, Heartlands Hospital, CRC Institute for Cancer Studies, Birmingham, United Kingdom. thoracic@dal.ca
Darnton
S J
SJ
Subramanian
S
S
Hiller
L
L
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002299:Cardia / Q000473:pathology / Q000601:surgery; D004396:Coloring Agents; D016001:Confidence Intervals; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000473:pathology; D005260:Female; D005456:Fluorescent Dyes; D005544:Forecasting; D005629:Frozen Sections; D006801:Humans; D008297:Male; D008866:Microsurgery; D009367:Neoplasm Staging; D016017:Odds Ratio; D016016:Proportional Hazards Models; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery; D015996:Survival Rate
D004396:Coloring Agents; D005456:Fluorescent Dyes