title: The impact of operative approach for oesophageal cancer on outcome: the transhiatal approach may influence circumferential margin involvement.
abstract: OBJECTIVE
  Surgery for oesophageal cancer remains the only means of cure for invasive tumours. It is claimed that the surgical approach for these cancers impacts on morbidity and may influence the ability to achieve tumour clearance and therefore survival, however there is no conclusive evidence to support one approach over another. This study aims to determine the impact of operative approach on tumour margin involvement and survival.
  
  
  METHODS
  Data were extracted from the Scottish Audit of Gastric and Oesophageal Cancer (SAGOC), a prospective population-based audit of all oesophageal and gastric cancers in Scotland between 1997 and 1999 with a minimum of five-year follow up. Analysis focused on the three commonest approaches (Ivor Lewis n = 140, transhiatal n = 68, left thoraco-laparotomy n = 142) for oesophageal cancer.
  
  
  RESULTS
  Operative approach had no significant impact on post-operative morbidity, mortality, overall margin involvement and survival. Transhiatal approach resulted in significantly more circumferential margin involvement (p = 0.019), and the presence of circumferential margin involvement significantly reduced five-year survival (median survival 13 months) compared to no margin involvement (median survival 25 months, p = 0.001).
  
  
  CONCLUSIONS
  Surgical approach for oesophageal cancer had no significant effect on morbidity, post-operative mortality and five-year survival. Non-selective use of the transhiatal approach is associated with a significantly greater circumferential margin involvement, with positive circumferential margin impacting adversely on 5-year survival.
authors.affiliation: Department of Surgery and Molecular Oncology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, United Kingdom. sasuttie@hotmail.com
authors.forename: S A
authors.initials: SA
authors.lastname: Suttie
authors.forename: S
authors.initials: S
authors.lastname: Nanthakumaran
authors.forename: R
authors.initials: R
authors.lastname: Mofidi
authors.forename: T
authors.initials: T
authors.lastname: Rapson
authors.forename: F J
authors.initials: FJ
authors.lastname: Gilbert
authors.forename: A M
authors.initials: AM
authors.lastname: Thompson
authors.forename: K G M
authors.initials: KG
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D004943:Esophagogastric Junction / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007813:Laparotomy / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology; D018570:Risk Assessment; D012606:Scotland; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome