Appropriate Proximal Resection Margin Distance for Esophagogastric Junction Adenocarcinoma.

Abstract

The purpose of this study was to clarify the appropriate proximal resection margin distance for esophagogastric junction (EGJ) adenocarcinoma and evaluate the impact on long-term outcomes. Proximal resection margin and lymph node dissection are critical factors in EGJ adenocarcinoma surgery. However, there is no clear consensus on the appropriate proximal resection margin distance to ensure negative margins, and the prognostic implications are unknown. This retrospective study included 116 patients with Siewert type II/III EGJ adenocarcinoma who underwent lower esophagectomy with proximal or total gastrectomy. The parameter, delta proximal margin (ΔPM), was used to analyze the discrepancy between gross and pathological proximal margins, while ΔPM' accounted for shrinkage during formalin fixation. Margin recommendations were stratified by cancer stage and histological type, and long-term outcomes were analyzed using survival statistics. Data for 109 patients were analyzed. Recommended gross resection margins ≥ 9 mm were necessary for early stage cancer, ≥ 15 mm for differentiated advanced cancer, and ≥ 21 mm for undifferentiated advanced cancer. Large tumor size (≥ 40 mm) was significantly associated with longer ΔPM' (p = 0.028). In advanced cancers, patients with a gross resection margin < 15 mm had significantly worse relapse-free survival than those with a gross resection margin ≥ 15 mm (p = 0.038). This margin cutoff was a significant prognostic factor in the multivariate analysis (p = 0.017). A gross proximal margin of at least 15 mm appears to reduce positive margins and confer survival advantage for advanced EGJ adenocarcinoma.