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Abstract Background The oesophagogastric (OG) tertiary referral centre at our Trust was established in March 2009.It caters to a catchment population of approximately 1.6 million. Oesophageal cancer is a morbid disease contributing to 18% of cancer mortalities worldwide. Involvement of circumferential resection margin (CRM) is an indicator of poor prognosis. The aim was to calculate the microscopic positive resection rate in patients undergoing resections for oesophageal cancers, assess disease free survival (DFS) and overall survival (OS) in this cohort. Methods Patients undergoing oesophageal resections for cancer at our OG unit who satisfied the inclusion criteria - age18, operation with curative intent, adenocarcinoma and squamous cell cancer with a microscopic positive resection margin (R1) were included. Data was collected from the electronic patient record (Quadramed). Retrospective analysis was performed using MS Excel and IBM SPSS statistics Ver 27. Results A total of 640 oesophageal cancer resections performed between April 2009 - March 2023, who satisfied the inclusion criteria were included. Median age at surgery was 66 years. The R1 rate was 40% in our cohort (R0:R1 =380:260). Male to female ratio in the R1 cohort was 4:1. 98% (255 patients) had T3/T4 disease. 47.7% (124 patients developed recurrence. Of these, 83.8% (104 patients) developed distant metastasis and 16.2 %(20 patients) had locoregional metastasis. Median time to recurrence was 12 months and disease-free survival was also12 months. The OS at one year of 81% (140/260) was comparable to national data. Conclusion We conclude that locally advanced tumour staged T3 and above is the most likely cause for higher rate of CRM positivity. Other factors that could contribute is the lack of serosal layer in the oesophagus and the practise of ex situ removal of nodes from the main specimen in theatre which could potentially lead to stripping of the adventitia thus making the CRM falsely R1 during pathological staging. The R1 status however does not seem to affect the overall survival rate.
Vaz et al. (Sun,) studied this question.