The “Real R0”: A Resection Margin Smaller Than 0.1 cm is Associated with a Poor Prognosis After Oncologic Esophagectomy

Abstract

Background Although resection margin (R) status is a widely used prognostic factor after esophagectomy, the definition of positive margins (R1) is not universal. The Royal College of Pathologists considers R1 resection to be a distance less than 0.1 cm, whereas the College of American Pathologists considers it to be a distance of 0.0 cm. This study assessed the predictive value of R status after oncologic esophagectomy, comparing survival and recurrence among patients with R0 resection (> 0.1-cm clearance), R0+ resection (≤ 0.1-cm clearance), and R1 resection (0.0-cm clearance). Methods The study enrolled all eligible patients undergoing curative oncologic esophagectomy between 2012 and 2018. Clinicopathologic features, survival, and recurrence were compared for R0, R0+, and R1 patients. Categorical variables were compared with the chi-square or Fisher’s test, and continuous variables were compared with the analysis of variance (ANOVA) test, whereas the Kaplan-Meier method and Cox regression were used for survival analysis. Results Among the 160 patients included in this study, 113 resections (70.6%) were R0, 34 (21.3%) were R0+, and 13 (8.1%) were R1. The R0 patients had a better overall survival (OS) and disease-free survival (DFS) than the R0+ and R1 patients. The R0+ resection offered a lower long-term recurrence risk than the R1 resection, and the R status was independently associated with DFS, but not OS, in the multivariate analysis. Both the R0+ and R1 patients had significantly more adverse histologic features (lymphovascular and perineural invasion) than the R0 patients and experienced more distant and locoregional recurrence. Conclusions Although R status is an independent predictor of DFS after oncologic esophagectomy, the < 0.1-cm definition for R1 resection seems more appropriate than the 0.0-cm definition as an indicator of poor tumor biology, long-term recurrence, and survival.

Neoadjuvant Chemoradiotherapy versus Chemotherapy for Gastroesophageal Junction Adenocarcinoma; Which Is the Optimal Treatment Option?

“…Postoperative complications were graded according to the validated 5-scale Clavien classification, and major morbidity was defined as a grade >IIIAc [ 19 ]. The 8th version of the UICC/TNM system was used to assess the baseline and histologic tumor stage [ 20 ] whereas R0 status was defined as a <1 mm microscopic margin from the tumor [ 21 ]. The primary outcome was the rate of pathological complete response (pCR) in RCT and CT patients; this was defined as the complete sterilization of the primary tumor (TRG1 grade according to the Mandard regression system) [ 22 ].…”

Preoperative administration of camrelizumab combined with chemotherapy for borderline resectable esophageal squamous cell carcinoma (BRES-1): A single-arm, open-label, phase II study

“…The secondary endpoints will be (1) major pathological response (MPR), which will be recorded when 10% or fewer viable tumor cells are observed in the surgical resection specimen (14), and (2) the conversion rate of surgery and R0 resection rate. R0 resection will be de ned as a negative proximal, distal, and circumferential resection margin (15,16). The quality of life and nutritional status of patients will be assessed using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and EORTC QLQ EC questionnaire (OES18) (17,18).…”

178. Neoadjuvant Chemoradiotherapy Versus Chemotherapy for Gastroesophageal Junction Adenocarcinoma; Which Is the Optimal Treatment Option?

“…Postoperative complications were graded according to the validated 5-scale Clavien classification, and major morbidity was defined as a grade >IIIAc [19]. The 8th version of the UICC/TNM system was used to assess the baseline and histologic tumor stage [20] whereas R0 status was defined as a <1 mm microscopic margin from the tumor [21]. The primary outcome was the rate of pathological complete response (pCR) in RCT and CT patients; this was defined as the complete sterilization of the primary tumor (TRG1 grade according to the Mandard regression system) [22].…”