Law S, Arcilla C, Chu K M, Wong J
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, China.
Am J Surg. 1998 Sep;176(3):286-90. doi: 10.1016/s0002-9610(98)00140-8.
Microscopic tumor infiltration of the resection margin after esophageal resection is implicated to influence anastomotic leakage, tumor recurrence rates, and long-term survival.
Patients with tumor infiltration of resection margin (RM+) and those without (RM-) were compared.
Of 604 patients, 45 (7.5%) were RM+. Patients in the RM+ group had more palliative resections, 76% versus 56%, P = 0.01. Anastomotic leakage rates were 2.2% (RM+) and 4.1% (RM-), P = 1.0. Excluding hospital deaths, anastomotic recurrences developed in 10.3% in the RM+ group and 4.9% in the RM- groups, P = 0.15. Although a positive margin did not increase anastomotic recurrence, a shorter resection margin correlated with such recurrence. The mean (SEM) lengths of resection margins in surgical specimens were 2.7 cm (0.3) and 4.4 cm (0.1) for those with and without recurrence, P < 0.001. Median survival time were 8.8 months (RM+) and 15 months (RM-), P = 0.007.
Histologic infiltration of resection margins did not influence leakage rate. Anastomotic recurrence was related to the length of resection margin.
食管切除术后切缘的微观肿瘤浸润被认为会影响吻合口漏、肿瘤复发率和长期生存率。
对切缘有肿瘤浸润（RM+）和无肿瘤浸润（RM-）的患者进行比较。
在604例患者中，45例（7.5%）为RM+。RM+组患者的姑息性切除更多，分别为76%和56%，P = 0.01。吻合口漏发生率分别为2.2%（RM+）和4.1%（RM-），P = 1.0。排除医院死亡病例后，RM+组吻合口复发率为10.3%，RM-组为4.9%，P = 0.15。虽然切缘阳性并未增加吻合口复发，但切缘较短与这种复发相关。手术标本中切缘的平均（SEM）长度，复发患者和未复发患者分别为2.7 cm（0.3）和4.4 cm（0.1），P < 0.001。中位生存时间分别为8.8个月（RM+）和15个月（RM-），P = 0.007。
切缘的组织学浸润不影响漏出率。吻合口复发与切缘长度有关。
