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 bo th local recurrence and survival. Similar prospective data have not been re ported for oesophageal carcinoma and we wished to ascertain the prognostic importance of this variable following potentially curative resection for oe sophageal carcinoma. Aim-To prospectively assess the impact of circumferential margin involvemen t (tumour within 1 mm) following potentially curative resection for oesopha geal carcinoma. Patients and methods-In a prospective study, resection specimens of 135 pat ients treated with potentially curative oesophageal resection alone were st udied for the presence of tumour within 1 mm of the circumferential margin (margin positive), using inked margins and cross sectional slicing of the s pecimen. All tumours were also staged using the 1987 UICC TNM classificatio n. Patients were followed for a mean of 19 months, and overall and cancer s pecific survival analysed. Results-The finding of tumour cells within 1 mm of the circumferential marg in (CRM+) was a significant and independent predictor of survival following potentially curative oesophageal resection. Overall, 64 (47%) patients wer e CRM+. Median survival in this group was 21 months compared with 39 months in the CRM- group (p=0.015). The impact of CRM status on survival was only seen in patients with a low nodal metastatic burden (<25% nodes positive). The odds ratio for the risk of dying from oesophageal cancer was 2.08 when the CRM was involved (p=0.013). Conclusions-The presence of tumour within 1 mm of the circumferential margi n following potentially curative resection for oesophageal carcinoma is an important independent prognostic variable and should be reported routinely.