Is an involved circumferential resection margin following oesphagectomy for cancer an important prognostic indicator?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether an involved circumferential resection margin (CRM) following oesophagectomy for cancer is an independent predictor of poor long-term survival. Six hundred and fourteen papers were found using the reported search, of which seven represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and results of these papers are tabulated. Of these studies, four were conducted on patients who predominantly did not receive preoperative chemotherapy and showed conflicting results as to the prognostic significance of CRM involvement. However, three later studies conducted on patients who predominantly did receive preoperative chemotherapy showed that CRM involvement to be an independent predictor of long-term survival. We conclude that for patients who undergo oesophagectomy alone as a treatment for oesophageal cancer, the prognostic importance of CRM involvement is unclear. However, for patients who undergo preoperative chemotherapy prior to surgery, there does appear to be emerging evidence supporting the concept that CRM involvement is an independent predictor of poor long-term outcome.