The impact of operative approach for oesophageal cancer on outcome: The transhiatal approach may influence circumferential margin involvement

• Published in: European journal of surgical oncology Vol. 38; no. 2; pp. 157 - 165
• Main Authors: Suttie, S.A, Nanthakumaran, S, Mofidi, R, Rapson, T, Gilbert, F.J, Thompson, A.M, Park, K.G.M
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2012
• Subjects: Adult; Aged; Aged, 80 and over; Analysis of Variance; Chi-Square Distribution; Circumferential margin; Cohort Studies; Confidence Intervals; Databases, Factual; Disease-Free Survival; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy - methods; Esophagectomy - mortality; Esophagogastric Junction - pathology; Esophagogastric Junction - surgery; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Ivor Lewis; Kaplan-Meier Estimate; Laparotomy - methods; Logistic Models; Male; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Staging; Oesophageal cancer; Postoperative Complications - mortality; Postoperative Complications - pathology; Risk Assessment; Scotland; Surgery; Survival; Survival Analysis; Thoraco-laparotomy; Thoracotomy - methods; Transhiatal; Treatment Outcome; Scotland; Oesophageal cancer; Thoraco-laparotomy; Circumferential margin; Survival; Ivor Lewis; Transhiatal
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2011.11.008

Abstract Aim Surgery for oesophageal cancer remains the only means of cure for invasive tumours. It is claimed that the surgical approach for these cancers impacts on morbidity and may influence the ability to achieve tumour clearance and therefore survival, however there is no conclusive evidence to support one approach over another. This study aims to determine the impact of operative approach on tumour margin involvement and survival. Methods Data were extracted from the Scottish Audit of Gastric and Oesophageal Cancer (SAGOC), a prospective population-based audit of all oesophageal and gastric cancers in Scotland between 1997 and 1999 with a minimum of five-year follow up. Analysis focused on the three commonest approaches (Ivor Lewis n  = 140, transhiatal n  = 68, left thoraco-laparotomy n  = 142) for oesophageal cancer. Results Operative approach had no significant impact on post-operative morbidity, mortality, overall margin involvement and survival. Transhiatal approach resulted in significantly more circumferential margin involvement ( p  = 0.019), and the presence of circumferential margin involvement significantly reduced five-year survival (median survival 13 months) compared to no margin involvement (median survival 25 months, p  = 0.001). Conclusion Surgical approach for oesophageal cancer had no significant effect on morbidity, post-operative mortality and five-year survival. Non-selective use of the transhiatal approach is associated with a significantly greater circumferential margin involvement, with positive circumferential margin impacting adversely on 5-year survival.