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Ann Thorac Surg 2000;69:205-209
© 2000 The Society of Thoracic Surgeons

Original Articles

What is the optimal distal resection margin for esophageal carcinoma?

Alan G. Casson, FRCSCa, S. Jane Darnton, PhDa, Sujata Subramanian, FRCSa, Louise Hiller, BSca

a Regional Department of Thoracic Surgery, Heartlands Hospital, Birmingham Clinical Trials Unit, CRC Institute for Cancer Studies, Birmingham, United Kingdom

Address reprint requests to Dr Casson, Division of Thoracic Surgery, QEII Health Sciences Centre, Victoria Building 7S-008, 1278 Tower Rd, Halifax, NS B3H 2Y9, Canada
e-mail: thoracic{at}dal.ca

Presented at the Poster Session of the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.

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.




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