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Proximal Resection Margin in Ivor-Lewis Oesophagectomy for Cancer

Qureshi, YA; Sarker, S-J; Walker, RC; Hughes, SF; (2017) Proximal Resection Margin in Ivor-Lewis Oesophagectomy for Cancer. Annals of Surgical Oncology , 24 (2) pp. 569-577. 10.1245/s10434-016-5510-y. Green open access

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Abstract

OBJECTIVE: The purpose of this study was to investigate whether a long proximal oesophageal resection margin (PRM) is associated with improved survival after oesophagectomy for cancer and to identify the optimal margin to aim for in this patient group. METHODS: A prospectively maintained database identified 174 patients who underwent Ivor-Lewis oesophagectomy for cancer. Demographic, clinical, and pathological data were collected. X-tile software was used to identify the optimal resection point. Two models were analysed: single point resection with comparison of two groups (short and long), and two resection points with three groups (short, medium, and long) to provide a range. RESULTS: The median PRM was 4.0 cm (interquartile range: 2.5-6.0 cm). After adjustment for significant confounders, multivariable Cox PH analysis demonstrated that the optimal resection margin was 1.7 cm, and in the three-group analysis the optimum PRM was between 1.7 and 3 cm. In the two-group analysis, the long margin had no effect on DFS (p = 0.37), but carried a significantly improved overall survival (hazard ratio [HR] = 0.46, 95 % confidence interval [CI] 0.25-0.87, p = 0.02). In the three-group analysis, the medium and long groups had improved OS compared with the short group (on average 54 %, HR ≥ 0.45, p ≤ 0.04). The 5-year disease-free and overall survival rates were highest in the medium PRM group (48 and 57 % respectively). CONCLUSIONS: Optimal survival following oesophagectomy for cancer is achieved with a PRM > 1.7 cm, but a PRM > 3 cm does not yield a further survival advantage. Thus, the optimal PRM is likely to be between 1.7 and 3 cm.

Type: Article
Title: Proximal Resection Margin in Ivor-Lewis Oesophagectomy for Cancer
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1245/s10434-016-5510-y
Publisher version: https://doi.org/10.1245/s10434-016-5510-y
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Adenocarcinoma, Aged, Carcinoma, Small Cell, Carcinoma, Squamous Cell, Esophageal Neoplasms, Esophagectomy, Female, Follow-Up Studies, Humans, Male, Margins of Excision, Middle Aged, Prognosis, Prospective Studies, Survival Rate
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > UCL Medical School
URI: http://discovery.ucl.ac.uk/id/eprint/10060658
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