Oral Presentations: Circumferential Resection Margins in Oesophageal Carcinoma: A New Approach
نویسندگان
چکیده
Circumferential resection margin (CRM) status is considered to be a significant factor in determining the prognosis and disease free survival of patients with oesophageal carcinoma. The two most commonly used classification systems to define CRM status are described by the Royal College of Pathologists (RCPath) and the College of American Pathologists (CAP). According to RCPath criteria, CRM is involved (R1) if tumour is present within 1 mm of the resection margin. On the other hand, CAP designates R1 status only if tumour is present at the CRM of the resection specimen. Consensus is clearly required in the classification of CRM status to avoid confusion in comparisons between cohorts classified using these different systems. This study compared the CRM status, assessed by both classifications, and the overall survival of patients with oesophageal carcinoma treated by surgical resection, within a population-based cancer registry in Northern Ireland. All patients who had undergone oesophagectomy and were diagnosed to have a pathological stage T3 tumour between January 2000 and December 2007 were identified from the Northern Ireland Cancer Registry. The pathology reports were examined for RCPath and CAP CRM status by two independent assessors. In cases where clear-cut information about CRM status was not reported, specifically the actual distance in mm to CRM, the archived histopathology slides were reviewed to ascertain classification. 129 patients with T3 oesophageal cancer (all types) were identified. All patients were available at follow up. Male to female ratio was 2:1 (87 males, 42 females) with median age 66 years. 49 patients (37%) received neo-adjuvant chemotherapy and 10 (8%) received both pre and post-operative chemotherapy. According to the RCPath CRM classification, 34 resections were R0 and 95 were R1 within this cohort of patients. Median survivals were 67 and 18 months respectively. When the CAP criterion was applied, 89 patients were R0 and 40 R1. Using the CAP classification, median survival was 65 months for R0 and 12 months for the R1 group. The survival difference between R0 and R1 remained statistically significant, regardless if patients were classified by RCPath or CAP criteria. Patients were then divided into three groups: CRM clear by > 1mm in group 1, 0-1 mm in group 2 and tumour present at the resection margin (0mm) in group 3. Categorisation into these three groups revealed median survivals of 89, 26 and 12 months respectively. Kaplan-Meier analysis showed statistically significant differences in survival for the three groups. …
منابع مشابه
Circumferential resection margin involvement: an independent predictor of survival following surgery for oesophageal cancer.
BACKGROUND For rectal carcinoma, the presence of tumour within 1 mm of the circumferential margin is an important independent prognostic factor for both local recurrence and survival. Similar prospective data have not been reported for oesophageal carcinoma and we wished to ascertain the prognostic importance of this variable following potentially curative resection for oesophageal carcinoma. ...
متن کاملEmerging aspects of oesophageal and gastro-oesophageal junction cancer histopathology – an update for the surgical oncologist
Adenocarcinoma of the oesophagus and gastro-oesophageal junction are rapidly increasing in incidence and have a well described sequence of carcinogenesis: the Barrett's metaplasia-dysplasia-adenocarcinoma sequence. During recent years there have been changes in the knowledge surrounding disease progression, cancer management and histopathology specimen reporting. Tumours around the gastro-oesop...
متن کاملDefining a positive circumferential resection margin in oesophageal cancer and its implications for adjuvant treatment.
BACKGROUND A positive circumferential resection margin (CRM) has been associated with a poorer prognosis in oesophageal and oesophagogastric junctional (OGJ) cancer. The College of American Pathologists defines the CRM as positive if tumour cells are present at the margin, whereas the Royal College of Pathologists also include tumour cells within 1 mm of this margin. The relevance of these diff...
متن کاملAssessment of Surgeon Judgment during Resection of Laryngeal Carcinoma
Carbon dioxide (CO2) laser surgery as a conservative tool plays a peculiar role in the management of head and neck cancer. Numerous patients who were candidates for transoral laryngeal microsurgery have forced us to eliminate frozen-section evaluation of surgical margins and use a magnified view of the larynx. The present study evaluated surgeon-judged negative margins with permanent microscopi...
متن کاملThe impact of operative approach on outcome of surgery for gastro-oesophageal tumours
BACKGROUND The choice of operation for tumours at or around the gastro-oesophageal junction remains controversial with little evidence to support one technique over another. This study examines the prevalence of margin involvement and nodal disease and their impact on outcome following three surgical approaches (Ivor Lewis, transhiatal and left thoraco-laparotomy) for these tumours. METHODS A...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
دوره 82 شماره
صفحات -
تاریخ انتشار 2013