Background
In esophageal cancer, circumferential resection margins (CRMs) are considered to be of relevant prognostic value, but a reliable
definition of tumor-free CRM is still unclear. The aim of this study was to appraise the clinical prognostic value of microscopic
CRM involvement and to determine the optimal limit of CRM.
Methods
To define the optimal tumor-free CRM we included 98 consecutive patients who underwent extended esophagectomy with microscopic
tumor-free resection margins (R0) between 1997 and 2006. CRMs were measured in tenths of millimeters with inked lateral margins.
Outcome of patients with CRM involvement was compared with a statistically comparable control group of 21 patients with microscopic
positive resection margins (R1).
Results
A cutoff point of CRM at ≤1.0 mm and >1.0 mm appeared to be an adequate marker for survival and prognosis (both P < 0.001). The outcome in patients with CRMs ≤1.0 and >0 mm was equal to that in patients with CRM of 0 mm (P = 0.43). CRM involvement was an independent prognostic factor for both recurrent disease (P = 0.001) and survival (P < 0.001). Survival of patients with positive CRMs (≤1 mm) did not significantly differ from patients with an R1 resection
(P = 0.12).
Conclusion
Involvement of the circumferential resection margins is an independent prognostic factor for recurrent disease and survival
in esophageal cancer. The optimal limit for a positive CRM is ≤1 mm and for a free CRM is >1.0 mm. Patients with unfavorable
CRM should be approached as patients with R1 resection with corresponding outcome.
Presented at the Gastrointestinal Cancers Symposium 2009 in San Francisco and at the 62nd Cancer Symposium 2009 of the Society
of Surgical Oncology in Phoenix.