title: Clinical impact of tumour involvement of the anastomotic doughnut in oesophagogastric cancer surgery.
abstract: BACKGROUND
  Published colorectal cancer surgery data suggest no role for the analysis of the anastomotic doughnuts following anterior resection. The usefulness of routine histological analysis of the upper gastrointestinal doughnut is not clear. Our study assessed the impact of cancer involvement of the doughnut on clinical practice. Factors associated with doughnut involvement and the effect on patients' survival were also analysed.
  
  
  METHODS
  The clinicopathological details of 462 patients who underwent potentially curative oesophagogastrectomy for cancer with a stapled anastomosis between 1994 and 2006 in two specialist centres were retrospectively analysed. Univariate, multivariate and survival analyses were carried out.
  
  
  RESULTS
  Approximately 5% of doughnuts (22 of 462) were histologically involved with cancer. Microscopic involvement of the proximal resection margin, local lymph node metastasis and lymphatic invasion within the main resected specimen were independently associated with doughnut involvement (all P < 0.05). However, these three factors taken together failed to predict doughnut involvement. Doughnut involvement was an independent adverse prognostic factor for overall survival (P = 0.0013).
  
  
  CONCLUSIONS
  In contrast to findings in colorectal surgery, doughnut involvement with cancer appears to have useful prognostic information following oesophagogastrectomy. Routine histological analysis of upper gastrointestinal doughnuts is justified. Doughnut involvement could potentially strengthen the indications for adjuvant therapy in the future.
authors.affiliation: Department of Gastrointestinal Surgery, University Hospital of South Manchester NHS Foundation Trust, UK.
authors.forename: K
authors.initials: K
authors.lastname: Sillah
authors.forename: E A
authors.initials: EA
authors.lastname: Griffiths
authors.forename: S A
authors.initials: SA
authors.lastname: Pritchard
authors.forename: R
authors.initials: R
authors.lastname: Swindell
authors.forename: C M
authors.initials: CM
authors.lastname: West
authors.forename: R
authors.initials: R
authors.lastname: Page
authors.forename: I M
authors.initials: IM
authors.lastname: Welch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000714:Anastomosis, Surgical; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009366:Neoplasm Seeding; D012189:Retrospective Studies; D017792:Surgical Stapling; D016019:Survival Analysis; D016896:Treatment Outcome