Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2013

01-03-2013 | Gastrointestinal Oncology

Significant Variation of Resected Meso-esophageal Tissue Volume in Two-Stage Subtotal Esophagectomy Specimens: A Retrospective Morphometric Study

Authors: Amy S. Izon, BSc (Hons.), Paul Jose, MS, Jeremy D. Hayden, MD, Heike I. Grabsch, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2013

Login to get access

Abstract

Background

Differences in the extent and quality of surgical resection for esophageal cancer may influence the pathological staging and patient outcome. There are no data in the literature qualitatively and/or quantitatively characterizing esophagectomy specimens.

Methods

Macroscopic images of 161 esophagectomy specimens were analyzed retrospectively. The extent of resection was qualitatively classified as “muscularis propria,” “intra-meso-esophageal,” or “meso-esophageal.” The volume of meso-esophageal tissue was quantified morphometrically. The number of muscle defects per specimen was counted. Results were related to clinicopathological variables, including survival.

Results

Sixty-two (39 %) specimens were classified as “muscularis propria,” 65 (40 %) as “intra-meso-esophageal,” and 34 (21 %) as “meso-esophageal.” The morphometrically measured meso-esophageal tissue volume was different between the three types (P < 0.001). The specimen type was related to the total number of lymph nodes (P = 0.02), number of metastatic lymph nodes (P = 0.024), and depth of tumor invasion (P = 0.013), but not related to extramural tumor volume, circumferential resection margin status, or the surgeon performing the resection. The number of muscle defects per specimen was similar in all resection types. The resection specimen classification was related to survival in patients treated by surgery alone (P = 0.027).

Conclusions

This is the first study to quantify and classify the volume of tissue resected during esophagectomy. Our study shows significant variation of the resected tissue volume impacting pathological tumor staging. This variation was not associated with individual surgeon performance. A prospective, multicenter study is needed to validate our results and to investigate the potential biological mechanisms influencing the resectable volume of meso-esophageal tissue in cancer patients.
Literature
1.
2.
Altorki N, Zhou X, Stiles B, et al. Total number of resected lymph nodes predicts survival in esophageal cancer. Ann Surg. 2008;248:221–6.PubMedCrossRef
3.
Cromwell D, Palser T, van der Meulen J, et al. The national oesophago-gastric cancer audit. An audit of the care received by people with oesophago-gastric cancer in England and Wales. Third Annual Report. London. NHS Information Centre 2010.
4.
Medical Research Council Oesophageal Cancer Working Group. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet. 2002;359:1727–33.CrossRef
5.
Omloo J, Lagarde S, Hulscher J, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg. 2007;246:992–1001.PubMedCrossRef
6.
Grotenhuis B, van Heijl M, Zehetner J, et al. Surgical management of submucosal esophageal cancer. Extended or regional lymphadenectomy? Ann Surg. 2010;252:823–30.PubMedCrossRef
7.
Hsu P, Wang BY, Chou TY, et al. The total number of resected lymph nodes is not a prognostic factor for recurrence in esophageal squamous cell carcinoma patients undergone transthoracic esophagectomy. J Surg Oncol. 2011;103:416–20.PubMedCrossRef
8.
Santos R, Raftopoulos Y, Singh D, et al. Utility of total mechanical stapled cervical esophagectomy anastomosis after esophagectomy: a comparison to conventional anastomotic techniques. Surgery. 2004;136:917–25.PubMedCrossRef
9.
Berger A, Bloomenthal A, Weksler B, et al. Oncologic efficacy is not compromised, and may be improved with minimally invasive esophagectomy. J Am Coll Surg. 2011;212:560–8.PubMedCrossRef
10.
Forshaw M, Gossage J, Ockrim J, et al. Left thoracoabdominal esophagogastrectomy: still a valid operation for carcinoma of the distal esophagus and esophagogastric junction. Dis Esophagus. 2006;19:340–5.PubMedCrossRef
11.
Kim S, Lee K, Shim Y, et al. Esophageal resection: indications, techniques, and radiologic assessment. Radiographics. 2001;21:1119–40.PubMed
12.
Matsubara T, Ueda M, Nagao N, et al. Cervicothoracic approach for total mesoesophageal dissection in cancer of the thoracic esophagus. J Am Coll Surg. 1998;187:238–45.PubMedCrossRef
13.
The Royal College of Pathologists. Dataset for the histopathological reporting of oesophageal carcinoma. Mapstone N, editor. London, 2007.
14.
Bosman FT, Carneiro F, Hruban RH, et al., editors. WHO classification of tumours of the digestive system. Lyon, IARC Press, 2010.
15.
Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Cancer. 1994;73:2680–8.PubMedCrossRef
16.
Sobin L, Gospodarowicz M, Wittekind C, editors. UICC International Union Against Cancer: TNM classification of malignant tumours. Chichester, Wiley-Blackwell, 2010.
17.
Jamieson G, Lamb P, Thompson S. The role of lymphadenectomy in esophageal cancer. Ann Surg. 2009;250:206–9.PubMedCrossRef
18.
Martijnse IS, Dudink RL, West NP, et al. Focus on extralevator perineal dissection in supine position for low rectal cancer has led to better quality of surgery and oncologic outcome. Ann Surg Oncol. 2012;19:786–93.PubMedCrossRef
19.
West NP, Finan PJ, Anderin C, et al. Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol. 2008;26:3517–22.PubMedCrossRef
20.
West NP, Hohenberger W, Weber K, et al. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol. 2010;28:272–8.PubMedCrossRef
21.
Lerut T, Nafteux P, Moons J, et al. Quality in the surgical treatment of cancer of the esophagus and gastroesophageal junction. Eur J Surg Oncol. 2005;31:587–94.PubMedCrossRef
22.
Salih T, Jose P, Mehta SP, et al. Prognostic significance of cancer within 1 mm of the circumferential resection margin in oesophageal cancer patients following neo-adjuvant chemotherapy. Eur J Cardiothorac Surg. 2012 (epub ahead of print).
23.
West NP, Kobayashi H, Takahashi K, et al. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol. 2012;30:1763–9.PubMedCrossRef
24.
Marr R, Birbeck K, Garvican J, et al. The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg. 2005;242:74–82.PubMedCrossRef
25.
West NP, Morris EJ, Rotimi O, et al. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol. 2008;9:857–65.PubMedCrossRef
26.
West NP, Anderin C, Smith K, et al. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg. 2010;97:588–99.PubMedCrossRef
27.
Birbeck K, Macklin C, Tiffin N, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg. 2002;235:449–57.PubMedCrossRef
28.
Peyre C, Hagen J, DeMeester S, et al. The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg. 2008;248:549–56.PubMedCrossRef
29.
Hülscher J, van Sandick J, de Boer A, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;347:1662–9.PubMedCrossRef
30.
Kato H. Lymph node dissection for thoracic esophageal carcinoma. Two- and 3-field lymph node dissection. Ann Chir Gynaecol. 1995;84:193–9.PubMed
31.
Morgan MA, Lewis WG, Hopper AN, et al. Prognostic significance of body mass indices for patients undergoing esophagectomy for cancer. Dis Esophag. 2007;20:29–35.CrossRef
32.
Hayashi Y, Correa AM, Hofstetter WL, et al. The influence of high body mass index on the prognosis of patients with esophageal cancer after surgery as primary therapy. Cancer. 2010;116:5619–27.PubMedCrossRef
33.
Blom RL, Lagarde SM, Klinkenbijl JH, et al. A high body mass index in esophageal cancer patients does not influence postoperative outcome or long-term survival. Ann Surg Oncol. 2012;19:766–71.PubMedCrossRef
Metadata
Title
Significant Variation of Resected Meso-esophageal Tissue Volume in Two-Stage Subtotal Esophagectomy Specimens: A Retrospective Morphometric Study
Authors
Amy S. Izon, BSc (Hons.)
Paul Jose, MS
Jeremy D. Hayden, MD
Heike I. Grabsch, MD, PhD
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 3/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2659-x

Other articles of this Issue 3/2013

Annals of Surgical Oncology 3/2013 Go to the issue

Thoracic Oncology

Outcomes After Adjuvant Platinum-based Chemotherapy in Elderly NSCLC Patients with T4 Disease

Gynecologic Oncology

Laparoscopic Radical Hysterectomy after Preoperative Brachytherapy for Stage IB1 Cervical Cancer: Feasibility, Results, and Surgical Implications in a Large Bicentric Study of 162 Consecutive Cases

Reconstructive Oncology

Do Clinicopathological Features of the Cancer Patient Relate with Nipple Areolar Complex Necrosis in Nipple-Sparing Mastectomy?

Gastrointestinal Oncology

Impact of Obesity on Perioperative Complications and Long-term Survival of Patients with Gastric Cancer

Endocrine Tumors

Adrenal Histologic Findings Show No Difference in Clinical Presentation and Outcome in Primary Hyperaldosteronism

Gastrointestinal Oncology

Esophagus or Stomach? The Seventh TNM Classification for Siewert Type II/III Junctional Adenocarcinoma