Upper GI 2017
3/28/2017
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TheRoyalMarsden
surgicalauditgroup,January2011
TheRoyalMarsden
surgicalauditgroup,January2011
Type II French experience
Type II French experience – Anastomotic leak
Overall (all OGJ cancer)
9%
500 cases (42% all EGJ cancers)
Thoracic
10%
Oesophagogastrectomy
292 (58%)
Abdominal
6%
Extended total gastrectomy
203 (40%)
Thoracic oesophago-jejunal
14%
Other
5 (1%)
Sauvanet et al J Am Coll Surg 2005; 201: 253-62
Sauvanet et al J Am Coll Surg 2005; 201: 253-62
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TheRoyalMarsden
Aim of Resection
Proximal Margin according to surgery
Complete resection of primary tumour (R0)
Total Gastrectomy (n= 77)
2.0cm (0.1 – 6.5cm)
Clear margins
Oesophago- gastrectomy (n=199)
5.5cm (0.3 – 16.0cm)
Lymphadenectomy (>15 nodes)
Barbour et al Ann Surg 2007; 246: 1-8
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TheRoyalMarsden Circumferential resection margin (CRM) size correlates with overall survival Prospective database, single institution study, N = 229
Survival according to cephalad margin
Median Survival (95% CI)
CRM n
Positive 45 1.2 yrs (0.9-1.4) <1mm 48 1.9 yrs (1.4-3.2) 3.5 yrs (2.0–no upper CI) ≥ 2.0mm 105 Not reached 1.0-1.9mm 31
Kaplan-Meier curves of OS by margin size:
--->2.0mm ---1.0-1.9mm ---<1mm ---0mm
Probabilityof survival
Time (years)
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
Barbour et al Ann Surg 2007; 246: 1-8
Landauetal.,ESMO 2010 (Abstract 711PD)
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