Circumferential resection margin and early recurrence after neoadjuvant-treated hybrid ivor lewis esophagectomy: a single-center cohort study

The prognostic value of circumferential resection margin (CRM) width after neoadjuvant-treated esophagectomy remains uncertain. To assess whether CRM distance predicts early (12-month) locoregional recurrence (LRR) following hybrid Ivor-Lewis esophagectomy. Retrospective observational cohort at a tertiary cancer center, April 2023–October 2024. Consecutive adults who underwent two-stage (hybrid) esophagectomy for malignancy; emergencies and abandoned resections excluded. Pathologic CRM measured in millimeters, analyzed continuously and by RCPath thresholds (≤ 1 mm vs. > 1 mm). Primary—12-month locoregional recurrence (LRR). Secondary—any recurrence and recurrence-free survival (RFS). Sixty-three resections were analyzed. CRM was measurable in 45 (71.4%). Median CRM was 2.0 mm (IQR 1.0–3.0). Six patients (9.5%) developed recurrence within 12 months—five locoregional and one distant. One of twenty-nine pathological complete responders (pCR, 3.4%) recurred. Univariable analysis did not demonstrate a significant association between CRM distance and early recurrence. Kaplan–Meier analysis showed no statistically significant difference in recurrence-free survival between CRM categories. Early recurrence occurred in 9.5% of patients, predominantly locoregional. CRM distance, whether analyzed continuously or using RCPath thresholds, was not associated with early recurrence. These findings suggest that, within this single-center cohort, early relapse may reflect underlying tumor biology rather than marginal radial clearance, although results should be interpreted with caution given limited event numbers.