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TheRoyalMarsden
Type II
French experience
500 cases (42% all EGJ cancers)
Oesophagogastrectomy
292 (58%)
Extended total gastrectomy
203 (40%)
Other
5 (1%)
surgicalauditgroup,January2011
25
Sauvanet et al J Am Coll Surg 2005; 201: 253-62
TheRoyalMarsden
Type II
French experience – Anastomotic leak
Overall (all OGJ cancer)
9%
Thoracic
10%
Abdominal
6%
Thoracic oesophago-jejunal
14%
surgicalauditgroup,January2011
26
Sauvanet et al J Am Coll Surg 2005; 201: 253-62
TheRoyalMarsden
Aim of Resection
Complete resection of primary tumour (R0)
Clear margins
Lymphadenectomy (>15 nodes)
27
Proximal Margin according to surgery
28
Total Gastrectomy
(n= 77)
2.0cm (0.1 – 6.5cm)
Oesophago-
gastrectomy
(n=199)
5.5cm (0.3 – 16.0cm)
Barbour et al Ann Surg 2007; 246: 1-8
Survival according to cephalad margin
29
Barbour et al Ann Surg 2007; 246: 1-8
TheRoyalMarsden
Circumferential resection margin (CRM) size
correlates with overall survival
Prospective database, single institution study, N = 229
CRM size is a significant prognostic factor for overall
survival
40.6% of patients in this study had a CRM <1mm
Post operative chemoradiation did not alter survival in
patients with CRM <1mm
BUT smaller CRM may just reflect a larger tumour
Kaplan-Meier curves of OS by margin size:
Time (years)
Probabilityof
survival
--->2.0mm
---1.0-1.9mm
---<1mm
---0mm
CRM n
Median Survival
(95% CI)
Positive 45 1.2 yrs
(0.9-1.4)
<1mm 48 1.9 yrs
(1.4-3.2)
1.0-1.9mm 31
3.5 yrs
(2.0–no
upper CI)
≥ 2.0mm 105 Not reached
Landauetal.,ESMO 2010 (Abstract 711PD)