gms | German Medical Science

130. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

30.04. - 03.05.2013, München

Prognostic Impact of Microscopic Positive Surgical Margin in Neoadjuvantly Treated Esophagogastric Cancer Patients

Meeting Abstract

  • Thammawat Parakonthum - Universität Heidelberg Chirurgische Klinik, Viszeralchirurgie, Heidelberg
  • Susanne Blank - Universität Heidelberg Chirurgische Klinik, Viszeralchirurgie, Heidelberg
  • Wilko Weichert - Universität Heidelberg Pathologisches Institut, Pathologisches Institut, Heidelberg
  • Leila Sisic - Universität Heidelberg Chirurgische Klinik, Viszeralchirurgie, Heidelberg
  • Markus Büchler - Universität Heidelberg Chirurgische Klinik, Viszeralchirurgie, Heidelberg
  • Katja Ott - Universitätsklinikum Heidelberg, Chirurgische Klinik, Heidelberg

Deutsche Gesellschaft für Chirurgie. 130. Kongress der Deutschen Gesellschaft für Chirurgie. München, 30.04.-03.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13dgch079

doi: 10.3205/13dgch079, urn:nbn:de:0183-13dgch0799

Veröffentlicht: 26. April 2013

© 2013 Parakonthum et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Introduction: Most previous studies concerning the clinical significance of positive resection margin on patients’ outcome were based on the primary resection approach. This study focuses on the prognostic impact of microscopic positive margin in neoadjuvantly treated upper gastrointestinal cancer patients.

Material and methods: From 2001-2011, 256 patients with esophagogastric cancer were operated after neoadjuvant therapy (204 males, 52 females; 136 adenocarcinomas of esophagogastric junction (AEG), 58 gastric adenocarcinomas, 62 squamous cell carcinomas). Clinical, histopathological, demographic and follow-up data were analyzed from a database. 46 patients with microscopic positive surgical margin and 210 patients with negative margin were compared (chi-square, log-rank).

Results: Microscopic positive surgical margins were identified in 46 (18.0%) patients. Concerning tumor localization, positive margin occurred in 28 (20.6%) AEG (proximal:9, distant:1 deep:18), 11 (19.0%) gastric cancer (proximal: 5, distant 1: deep: 5), and 7 (11.3%) esophageal cancer (proximal:3, distant:1 deep:3) (p=0.316). From the preoperatively available factors, resection category (R) showed correlation with clinical response to chemotherapy (p<0.001). There was no association between R and tumor grading (p=0.153), Lauren’s classification (p=0.058), cT- (p=0.085) and cN-category (p=0.576). R had significant impact on survival (median survival: R0=40.5 months, R1=17.3 months, p<0.001). 106 (41.4%) patients had tumor recurrence or progression. Patients with R1 resection showed tumor progression significantly more often (56.5%) (p=0.019). Distant metastasis was the most common site of progression, followed by peritoneal carcinomatosis and locoregional recurrence. Within patients with positive resection margin, only pT-category was a prognostic factor (p<0.001).

Conclusion: In neoadjuvantly treated patients, R1 was associated with nonresponse to chemotherapy. Positive margins contribute to poor treatment outcomes in terms of early progression and poor survival. Surgical reasons for R1 are rare, as most R1 are localized at the deep resection margin. R1 leads more often to distant metastases than to local recurrence, which highlights the association with advanced ypT-categories.