Ralf Gertler1, Julia Richter1, Lynne Stecher2, Ulrich Nitsche1, Marcus Feith1. 1. Chirurgische Klinik und Poliklinik, Technische Universität München, Munich, Germany. 2. Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Abstract
BACKGROUND AND OBJECTIVES: The management of R1-resected adenocarcinoma of the esophagogastric junction (AEG) is unclear. We aimed to identify risk factors and prevalence of R1 resections, their recurrence and prognosis, and efficacy of postoperative therapy. METHODS: A single center cohort of 766 consecutive patients undergoing curative intent resection for AEG was analyzed retrospectively. RESULTS: R1-resection rate was 13%. Poorer tumor differentiation, higher T-, N-, and UICC/AJCC-stages were associated with R1-resections. Compared to R0-resected patients, R1-resected patients had a higher incidence of tumor recurrence (77% vs. 32%; P < 0.001) and worse overall survival (5-year overall survival 43% vs. 10%; P < 0.001). The pattern of recurrence did not differ between R0- and R1-resections with distant metastases in 90% and 87% of patients with tumor recurrence. We found a trend towards better overall survival for R1-resected patients receiving postoperative therapy compared to R1-resected patients without postoperative therapy (median 17.4 vs. 14.6 months, P = 0.056). CONCLUSIONS: The association of R1-resections with poor tumor characteristics allows for identification of patients at risk for R1-resection. As in R0-resections, tumor recurrence in R1-resections is mainly systemic, not local. The potential benefit of additive local postoperative therapies in R1-resected patients must be balanced against overall prognosis and therapy-specific morbidity and mortality. J. Surg. Oncol. 2016;114:428-433.
BACKGROUND AND OBJECTIVES: The management of R1-resected adenocarcinoma of the esophagogastric junction (AEG) is unclear. We aimed to identify risk factors and prevalence of R1 resections, their recurrence and prognosis, and efficacy of postoperative therapy. METHODS: A single center cohort of 766 consecutive patients undergoing curative intent resection for AEG was analyzed retrospectively. RESULTS: R1-resection rate was 13%. Poorer tumor differentiation, higher T-, N-, and UICC/AJCC-stages were associated with R1-resections. Compared to R0-resected patients, R1-resected patients had a higher incidence of tumor recurrence (77% vs. 32%; P < 0.001) and worse overall survival (5-year overall survival 43% vs. 10%; P < 0.001). The pattern of recurrence did not differ between R0- and R1-resections with distant metastases in 90% and 87% of patients with tumor recurrence. We found a trend towards better overall survival for R1-resected patients receiving postoperative therapy compared to R1-resected patients without postoperative therapy (median 17.4 vs. 14.6 months, P = 0.056). CONCLUSIONS: The association of R1-resections with poor tumor characteristics allows for identification of patients at risk for R1-resection. As in R0-resections, tumor recurrence in R1-resections is mainly systemic, not local. The potential benefit of additive local postoperative therapies in R1-resected patients must be balanced against overall prognosis and therapy-specific morbidity and mortality. J. Surg. Oncol. 2016;114:428-433.
Authors: Lucy X Ma; Osvaldo Espin-Garcia; Charles H Lim; Di M Jiang; Hao-Wen Sim; Akina Natori; Bryan A Chan; Chihiro Suzuki; Eric X Chen; Geoffrey Liu; Savtaj S Brar; Carol J Swallow; Jonathan C Yeung; Gail E Darling; Rebecca K Wong; Sangeetha N Kalimuthu; James Conner; Elena Elimova; Raymond W Jang Journal: J Gastrointest Oncol Date: 2020-04