title: What to do after R1-resection of adenocarcinomas of the esophagogastric junction?
abstract: OBJECTIVE
  The management of R1-resected adenocarcinoma of the esophagogastric junction (AEG) is unclear. We aimed to identify risk factors and prevalence of R1 resections, their recurrence and prognosis, and efficacy of postoperative therapy.
  
  
  METHODS
  A single center cohort of 766 consecutive patients undergoing curative intent resection for AEG was analyzed retrospectively.
  
  
  RESULTS
  R1-resection rate was 13%. Poorer tumor differentiation, higher T-, N-, and UICC/AJCC-stages were associated with R1-resections. Compared to R0-resected patients, R1-resected patients had a higher incidence of tumor recurrence (77% vs. 32%; P < 0.001) and worse overall survival (5-year overall survival 43% vs. 10%; P < 0.001). The pattern of recurrence did not differ between R0- and R1-resections with distant metastases in 90% and 87% of patients with tumor recurrence. We found a trend towards better overall survival for R1-resected patients receiving postoperative therapy compared to R1-resected patients without postoperative therapy (median 17.4 vs. 14.6 months, P = 0.056).
  
  
  CONCLUSIONS
  The association of R1-resections with poor tumor characteristics allows for identification of patients at risk for R1-resection. As in R0-resections, tumor recurrence in R1-resections is mainly systemic, not local. The potential benefit of additive local postoperative therapies in R1-resected patients must be balanced against overall prognosis and therapy-specific morbidity and mortality. J. Surg. Oncol. 2016;114:428-433. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Chirurgische Klinik und Poliklinik, Technische Universität München, Munich, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Gertler
authors.affiliation: Chirurgische Klinik und Poliklinik, Technische Universität München, Munich, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Richter
authors.affiliation: Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Lynne
authors.initials: L
authors.lastname: Stecher
authors.affiliation: Chirurgische Klinik und Poliklinik, Technische Universität München, Munich, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Nitsche
authors.affiliation: Chirurgische Klinik und Poliklinik, Technische Universität München, Munich, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Feith
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: esophagectomy; esophagogastric junction; gastrectomy; operative surgical procedures