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 pa
tients who underwent esophagectomy for squamous cell carcinomas (n = 50), p
rimary esophageal adenocarcinomas (n = 100), and adenocarcinomas of the car
dia (n = 39), in whom all macroscopic tumor was judged to be completely res
ected.
Results. Microscopic tumor was found at a 3-cm distal resection margin for
one multifocal squamous cell carcinoma. Positive distal resection margins w
ere 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 negativ
e; p = 0.02, Wilcoxon). Although pathologic stage was shown to be the only
significant predictor of overall survival (Hazard ratio [HR] 1.8; 95% confi
dence interval 1.2 to 2.6; p = 0.007), there was a trend toward reduced pos
toperative survival for patients with histologically positive distal resect
ion 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 belo
w the distal margin of the primary tumor. (C) 2000 by The Society of Thorac
ic Surgeons.