POSITIVE PROXIMAL RESECTION MARGINS AFTER RESECTION FOR CARCINOMA OF THE OESOPHAGUS AND STOMACH: EFFECT ON SURVIVAL AND SYMPTOM RECURRENCE

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Abstract
Background: Our aim was to determine the frequency, survival and symptomatic local recurrence rate of patients with a positive proximal resection margin in a series of patients having a resection for carcinoma of the oesophagus or stomach.Methods: A retrospective study of pathology reports and case notes. Survival and data on local recurrence were obtained from the patient or general practitioner.Results: Ten (11.5%) of 87 patients having a gastric or oesophageal resection for carcinoma had a positive proximal resection margin. All 10 patients underwent a palliative resection for late‐stage disease. Nine were dead at an average 8.3 months (range 2–20 months) post‐resection and one patient remains alive at 9 months. Only one of these 10 patients had evidence of a local recurrence with recurrent dysphagia prior to death at 11 months.Conclusion: A high incidence of a positive proximal resection margin was found. This occurred in patients who underwent a palliative resection for late‐stage disease, most of whom died before local recurrence became a problem. For patients recognized as having late‐stage disease, surgery for symptom palliation need not be aggressive (such as to include a thoracotomy) because achieving microscopic clearance is unlikely to affect the long‐term outcome.