Lack of Independent Significance of a Close (<1 mm) Circumferential Resection Margin Involvement in Esophageal and Junctional Cancer

Background For rectal cancer, an involved circumferential resection margin (CRM), defined as tumor cells within 1 mm of the CRM, is of established prognostic significance. This definition for the esophagus, however, is controversial, with the UK Royal College of Pathologists (RCP) recommending the 1 mm definition, while the College of American Pathologists (CAP) advises that only tumor cells at the cut margin (0 mm) define an incomplete (R1) resection. The aim of this study was to compare the clinical significance of both definitions in patients with pT3 tumors. Methods CAP- and RCP-defined CRM status in patients treated by surgery only or by multimodal therapy was recorded prospectively in a comprehensive database from May 2003 to May 2011. Kaplan–Meier survival curves were generated, and factors affecting survival were assessed by univariate and multivariate analysis. Results A total of 157 of 340 patients had pT3 esophageal tumors, with RCP-positive CRM in 60 %, and 18 % by CAP. There were no significant differences between RCP-positive CRM and negative margins for node-positive disease, local recurrence, and survival. CAP-positive CRM was associated with positive nodes ( P = 0.036) and poorer survival ( P = 0.023). Multivariate analysis revealed nodal invasion to be the only independent prognostic variable ( P = 0.004). Conclusions A CRM margin of