What is the optimal distal resection margin for esophageal carcinoma?
| Autor: | S. Jane Darnton, Louise Hiller, Sujata Subramanian, Alan G. Casson |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Microsurgery Esophageal Neoplasms medicine.medical_treatment Adenocarcinoma Esophagus Stomach Neoplasms medicine Carcinoma Confidence Intervals Odds Ratio Frozen Sections Humans Coloring Agents Survival rate Fluorescent Dyes Neoplasm Staging Proportional Hazards Models business.industry Esophageal disease Cardia Esophageal cancer medicine.disease Primary tumor Surgery Esophagectomy Survival Rate medicine.anatomical_structure Resection margin Carcinoma Squamous Cell Female Cardiology and Cardiovascular Medicine business Forecasting |
| Zdroj: | The Annals of thoracic surgery. 69(1) |
| ISSN: | 0003-4975 |
| Popis: | Background . Whereas a proximal resection margin of 12 cm is recommended for complete resection of esophageal cancer, the extent of distal resection is unclear. Methods . We examined distal resection margins in a consecutive series of patients who underwent esophagectomy for squamous cell carcinomas (n = 50), primary esophageal adenocarcinomas (n = 100), and adenocarcinomas of the cardia (n = 39), in whom all macroscopic tumor was judged to be completely resected. Results . Microscopic tumor was found at a 3-cm distal resection margin for one multifocal squamous cell carcinoma. Positive distal resection margins were seen in 12% (12 of 100 patients) of primary esophageal adenocarcinomas (median, 2 cm versus 4 cm if negative; p = 0.002, Wilcoxon) and 28% (11 of 39 patients) of cardia adenocarcinomas (median, 1 cm versus 3 cm if negative; p = 0.02, Wilcoxon). Although pathologic stage was shown to be the only significant predictor of overall survival (Hazard ratio [HR] 1.8; 95% confidence interval 1.2 to 2.6; p = 0.007), there was a trend toward reduced postoperative survival for patients with histologically positive distal resection margins, in particular for patients with cardia adenocarcinomas (median, 15.4 months versus 5.7 months if negative; p = 0.0001). Conclusions . To achieve consistently negative distal resection margins, we recommend resection of at least 5 cm of macroscopically normal foregut below the distal margin of the primary tumor. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|