What is the optimal distal resection margin for esophageal carcinoma?

Casson, Alan G.; Darnton, S. Jane; Subramanian, Sujata; Hiller, Louise

doi:10.1016/s0003-4975(99)01262-x

Cited by 65 publications

(34 citation statements)

References 21 publications

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“…2 In addition, gastroesophageal junction adenocarcinoma has a propensity to spread intramurally through the submucosal lymphatics, spreading both proximally up to the esophagus in the minority and distally down into the distal stomach in the majority. 7 Therefore, treatment is diffi cult and the prognosis is poor.…”

Section: Discussionmentioning

confidence: 99%

Gastroesophageal junction adenocarcinoma of young patients who underwent curative surgery: A comparative analysis with older group

Yoon

Kim

2011

Surg Today

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Section: Discussionmentioning

confidence: 99%

Gastroesophageal junction adenocarcinoma of young patients who underwent curative surgery: A comparative analysis with older group

Yoon

Kim

2011

Surg Today

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“…Given the rarity of this malignancy, the 48 tumors studied is a relatively large series, which is representative of the provincial population. Additional strengths of this study include that all tumors were treated in a consistent manner by a single university-based surgeon and that no patient received preoperative chemotherapy or radiation therapy, that all tumors were well staged pathologically with primary esophageal adenocarcinomas defined according to strict clinicopathologic criteria (22,23,25), and that follow-up and outcomes data were complete for all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Subtotal esophagectomy was done using a right transthoracic (31 patients) or transhiatal (17 patients) approach. A potentially curative resection was done, completely resecting all macroscopic tumor, with the thoracic and abdominal esophagus and the lesser curvature of the stomach, to achieve a minimum 5 cm distal resection margin as reported previously (22). Regional lymph node stations were resected extensively (two-field) and mapped to document patterns of metastasis.…”

Section: Methodsmentioning

confidence: 99%

Basic Fibroblast Growth Factor (FGF-2) Overexpression Is a Risk Factor for Esophageal Cancer Recurrence and Reduced Survival, which Is Ameliorated by Coexpression of the FGF-2 Antisense Gene

Barclay¹,

Li²,

Geldenhuys³

et al. 2005

Clinical Cancer Research

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Purpose:The basic fibroblast growth factor (FGF-2) gene is bidirectionally transcribed to generate overlapping sense and antisense (FGF-AS) mRNAs. FGF-AS has been implicated in the posttranscriptional regulation of FGF-2 expression. The aim of this study was to characterize FGF-2 and FGF-AS in esophageal cancer and to correlate their expression with clinicopathologic findings and outcome. Experimental Design: Reverse transcription-PCR was used to study FGF-2 and FGF-AS mRNA expression (normalized to glyceraldehyde-3-phosphate dehydrogenase) in 48 esophageal cancers relative to matched histologically normal esophageal epithelia (internal control). We used Cox proportional hazards analysis to calculate hazard ratios for recurrence and survival of patients with underexpression relative to the overexpression of FGF-2 and/or FGF-AS. Results: Overexpression of FGF-2 mRNA, by comparison with tumors underexpressing FGF-2, was associated with significantly increased risk for tumor recurrence (hazard ratio, 3.80; 95% confidence interval, 1.64-8.76) and reduced overall survival (hazard ratio, 2.11; 95% confidence interval, 1.0-4.58). When the effects of FGF-2 and FGF-AS were considered simultaneously, the association of FGF-2 mRNA overexpression with recurrence and mortality was even more pronounced, whereas FGF-AS mRNA overexpression was associated with reduced risk for recurrence and improved survival. Conclusions: Overexpression of FGF-2 mRNA is associated with tumor recurrence and reduced survival after surgical resection of esophageal cancer and that these risks are reduced in tumors coexpressing the FGF-AS mRNA. These data support the hypothesis that FGF-AS is a novel tumor suppressor that modulates the effect of FGF-2 expression and may have potential clinical application to the development of novel therapeutic strategies.

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“…Indeed, an esophagectomy is required in this case, but gastric tubulization could hinder the attainment of a safe distal margin. In the aforementioned study by Ito, a negative distal margin was found in all patients, with at least 4 cm of macroscopically free stomach below the tumor, while a 5-cm in vivo distal margin was advocated in a study from the UK [45,47].…”

Section: Resection Marginsmentioning

confidence: 99%

Western strategy for EGJ carcinoma

et al. 2016

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In this paper, the epidemiological and clinicobiological behavior of esophagogastric junction (EGJ) adenocarcinoma in the West is compared and contrasted to that in the East, and an overview is provided of current therapeutic strategies employed for this type of tumor in Western countries. It is well known that multimodal treatment is the therapeutic standard in locally advanced EGJ adenocarcinoma, but whether neoadjuvant/perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT) is the optimal approach is still debated. Neoadjuvant CRT improves local control in locally advanced Siewert type I and II tumors, so it should be considered the treatment of choice. In the subset of these patients with microscopic systemic disease at diagnosis, more intensive exclusive chemotherapy protocols could be of benefit. Therefore, there is an urgent need to identify these patients before planning the treatment. For Siewert type III tumors, perioperative chemotherapy is the standard. While there is general agreement on the optimal surgical approach for Siewert types I and III (a two-field Ivor Lewis operation and a total gastrectomy with distal esophagectomy, respectively), no standard surgical treatment has been defined for Siewert type II tumors. When data from Western series on proximal and circumferential resection margins and on nodal spread in Siewert type II tumors are taken into account, the optimal surgical approach appears to be Ivor Lewis esophagectomy. Whether the extent of esophageal invasion can correctly predict nodal involvement in middle-upper mediastinal stations as a means to restrict indications for transthoracic esophagectomy requires further investigation in the West.

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What is the optimal distal resection margin for esophageal carcinoma?

Cited by 65 publications

References 21 publications

Gastroesophageal junction adenocarcinoma of young patients who underwent curative surgery: A comparative analysis with older group

Gastroesophageal junction adenocarcinoma of young patients who underwent curative surgery: A comparative analysis with older group

Basic Fibroblast Growth Factor (FGF-2) Overexpression Is a Risk Factor for Esophageal Cancer Recurrence and Reduced Survival, which Is Ameliorated by Coexpression of the FGF-2 Antisense Gene

Western strategy for EGJ carcinoma

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