Comparison of circumferential resection margin clearance criteria with survival after surgery for cancer of esophagus

Abstract

Background: Circumferential resection margin (CRM) is widely recognized as an important prognostic factor in esophageal cancer. The aim of this study was to evaluate the clinical significance of CRM according to the current criteria of the Royal College of Pathologists (RCP) and the College of American Pathologists (CAP).

Methods: Patients (115) who underwent esophagectomy between 2000 and 2006 were included in this retrospective study. Factors such as neo-adjuvant therapy, site, histological type, size, and lymph node involvement were tested to determine predictability of CRM involvement. Along with these, age, sex, CRM, and adjuvant therapy were analyzed to determine influence on survival.

Results: On the basis of CRM, patients were divided into three groups (involved, 0.1-1 mm and >1mm). Size (T) was the only factor strongly predictive of CRM involvement (P < 0.001). Size (T; P = 0.04) and lymph node involvement (N; P = 0.0003) were found to significantly influence overall survival (OS). When patients with CRM (involved and 0.1-1mm) were compared with those with CRM > 1 mm, OS was significantly prolonged in the latter (P = 0.02).

Conclusion: This study appears to lend credence to the RCP criteria for definition of CRM over the CAP criteria.