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. 2023 Feb 1;277(2):e313-e319.
doi: 10.1097/SLA.0000000000005112. Epub 2023 Jan 10.

Risk Factors for Tumor Positive Resection Margins After Neoadjuvant Chemoradiotherapy for Esophageal Cancer: Results From the Dutch Upper GI Cancer Audit: A Nationwide Population-Based Study

Ingmar L Defize  1   2 , Lucas Goense  1 , Alicia S Borggreve  1 , Stella Mook  2 , Gert J Meijer  2 , Jelle P Ruurda  1 , Richard van Hillegersberg  1 ; Dutch Upper GI Cancer Audit Group
Affiliations

Risk Factors for Tumor Positive Resection Margins After Neoadjuvant Chemoradiotherapy for Esophageal Cancer: Results From the Dutch Upper GI Cancer Audit: A Nationwide Population-Based Study

Ingmar L Defize et al. Ann Surg. .

Abstract

Objective: To identify risk factors for tumor positive resection margins after neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy for esophageal cancer.

Summary background data: Esophagectomy after nCRT is associated with tumor positive resection margins in 4% to 9% of patients. This study evaluates potential risk factors for positive resection margins after nCRT followed by esophagectomy.

Methods: All patients who underwent an elective esophagectomy following nCRT in 2011 to 2017 in the Netherlands were included. A multivariable logistic regression was performed to assess the association between potential risk factors and tumor positive resection margins.

Results: In total, 3900 patients were included. Tumor positive resection margins were observed in 150 (4%) patients. Risk factors for tumor positive resection margins included tumor length (in centimeters, OR: 1.1, 95% CI: 1.0-1.1), cT4-stage (OR: 3.0, 95% CI: 1.2-6.7), and an Ivor Lewis esophagectomy (OR: 1.6, 95% CI: 1.0-2.6). Predictors associated with a lower risk of tumor positive resection margins were squamous cell carcinoma (OR: 0.4, 95% CI: 0.2-0.7), distal tumors (OR: 0.5, 95% CI: 0.3-1.0), minimally invasive surgery (OR: 0.6, 95% CI: 0.4-0.9), and a hospital volume of >60 esophagectomies per year (OR: 0.6, 95% CI: 0.4-1.0).

Conclusions: In this nationwide cohort study, tumor and surgical related factors (tumor length, histology, cT-stage, tumor location, surgical procedure, surgical approach, hospital volume) were identified as risk factors for tumor positive resection margins after nCRT for esophageal cancer. These results can be used to improve the radical resection rate by careful selection of patients and surgical approach and are a plea for centralization of esophageal cancer care.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Incidence of tumor positive resection margins (left y axis) and the total number of esophagectomies per year (right y axis) between 2011 and 2017. R+-resection indicates tumor positive resection margin.
Figure 2
Figure 2
A, Centralization of esophagectomies toward larger volume centers between 2011 and 2017. B, Trends in type of esophagectomy between 2011 and 2017.
Figure 3
Figure 3
The number of positive resection margins in Ivor Lewis procedures (left y axis) relative to the total number of Ivor Lewis procedures (right y axis) between 2011 and 2017. R1-resection indicates tumor positive resection margin.
See this image and copyright information in PMC

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