Upper GI 2017

3/28/2017

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TheRoyalMarsden

surgicalauditgroup,January2011

TheRoyalMarsden

surgicalauditgroup,January2011

Type II French experience

Type II French experience – Anastomotic leak

Overall (all OGJ cancer)

9%

500 cases (42% all EGJ cancers)

Thoracic

10%

Oesophagogastrectomy

292 (58%)

Abdominal

6%

Extended total gastrectomy

203 (40%)

Thoracic oesophago-jejunal

14%

Other

5 (1%)

Sauvanet et al J Am Coll Surg 2005; 201: 253-62

Sauvanet et al J Am Coll Surg 2005; 201: 253-62

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TheRoyalMarsden

Aim of Resection

Proximal Margin according to surgery

Complete resection of primary tumour (R0)

Total Gastrectomy (n= 77)

2.0cm (0.1 – 6.5cm)

Clear margins

Oesophago- gastrectomy (n=199)

5.5cm (0.3 – 16.0cm)

Lymphadenectomy (>15 nodes)

Barbour et al Ann Surg 2007; 246: 1-8

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TheRoyalMarsden Circumferential resection margin (CRM) size correlates with overall survival Prospective database, single institution study, N = 229

Survival according to cephalad margin

Median Survival (95% CI)

CRM n

Positive 45 1.2 yrs (0.9-1.4) <1mm 48 1.9 yrs (1.4-3.2) 3.5 yrs (2.0–no upper CI) ≥ 2.0mm 105 Not reached 1.0-1.9mm 31

Kaplan-Meier curves of OS by margin size:

--->2.0mm ---1.0-1.9mm ---<1mm ---0mm

Probabilityof survival

Time (years)

 CRM size is a significant prognostic factor for overall survival  40.6% of patients in this study had a CRM <1mm  Post operative chemoradiation did not alter survival in patients with CRM <1mm  BUT smaller CRM may just reflect a larger tumour

Barbour et al Ann Surg 2007; 246: 1-8

Landauetal.,ESMO 2010 (Abstract 711PD)

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