Neoadjuvant chemoradiotherapy followed by surgery for esophageal adenocarcinoma: Significance of microscopically positive circumferential radial margins

John A. Harvin, Guy Lahat, Arlene M. Correa, Jared Lee, Dipen Maru, Jaffer Ajani, Edith M. Marom, James Welsh, Manoop S. Bhutani, Garret Walsh, Jack Roth, Reza Mehran, Ara Vaporciyan, David Rice, Stephen Swisher, Wayne Hofstetter*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

Objectives: The incidence and consequence of an isolated involved circumferential radial margin (CRM) after resection for esophageal adenocarcinoma in the setting of neoadjuvant chemoradiotherapy (CRT) has not been reported. We aimed to determine the frequency and significance of a close (<1 mm) or involved CRM in patients undergoing esophagectomy after CRT. Methods: We retrospectively analyzed the data from patients undergoing resection from 1997 to 2008 for esophageal adenocarcinoma after neoadjuvant CRT. A positive CRM was defined as microscopic tumor at or less than 1 mm of the radial margin. An R1 resection was tumor at the radial margin. Only patients with ypT3 or greater tumors were included. R2 resections were excluded. Statistical comparisons were performed using Cox regression and Kaplan-Meier analyses. Results: A total of 160 patients met the inclusion criteria, 42 (26%) had a positive CRM. The median survival did not significantly differ between the CRM-negative and -positive groups (28 vs 50 months, P = .84). A propensity score matching analysis also failed to find a significant difference in outcomes. When analyzed by tumor present at the margin (R1), R0 patients had a longer median survival compared with R1 patients (28 vs 8 months, P = .01). This difference, however, was not seen on propensity score matching. Conclusions: Resections of locally advanced esophageal adenocarcinoma with residual transmural viable tumor after CRT frequently showed involvement of the radial margin with tumor either close to or at the margin. Tumor close (<1 mm) to the radial margin did not result in a significant decrease in overall or disease-free survival or increase in local recurrence.

Original languageEnglish
Pages (from-to)412-420
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume143
Issue number2
DOIs
StatePublished - Feb 2012
Externally publishedYes

Funding

FundersFunder number
National Cancer InstituteP30CA016672

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