What to do after R1-resection of adenocarcinomas of the esophagogastric junction?

J Surg Oncol. 2016 Sep;114(4):428-33. doi: 10.1002/jso.24329. Epub 2016 Jun 22.


Background and objectives: The management of R1-resected adenocarcinoma of the esophagogastric junction (AEG) is unclear. We aimed to identify risk factors and prevalence of R1 resections, their recurrence and prognosis, and efficacy of postoperative therapy.

Methods: A single center cohort of 766 consecutive patients undergoing curative intent resection for AEG was analyzed retrospectively.

Results: R1-resection rate was 13%. Poorer tumor differentiation, higher T-, N-, and UICC/AJCC-stages were associated with R1-resections. Compared to R0-resected patients, R1-resected patients had a higher incidence of tumor recurrence (77% vs. 32%; P < 0.001) and worse overall survival (5-year overall survival 43% vs. 10%; P < 0.001). The pattern of recurrence did not differ between R0- and R1-resections with distant metastases in 90% and 87% of patients with tumor recurrence. We found a trend towards better overall survival for R1-resected patients receiving postoperative therapy compared to R1-resected patients without postoperative therapy (median 17.4 vs. 14.6 months, P = 0.056).

Conclusions: The association of R1-resections with poor tumor characteristics allows for identification of patients at risk for R1-resection. As in R0-resections, tumor recurrence in R1-resections is mainly systemic, not local. The potential benefit of additive local postoperative therapies in R1-resected patients must be balanced against overall prognosis and therapy-specific morbidity and mortality. J. Surg. Oncol. 2016;114:428-433. © 2016 Wiley Periodicals, Inc.

Keywords: esophagectomy; esophagogastric junction; gastrectomy; operative surgical procedures.

MeSH terms

  • Adenocarcinoma / mortality
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Adult
  • Aged
  • Aged, 80 and over
  • Esophageal Neoplasms / mortality
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / surgery*
  • Esophagogastric Junction*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / surgery*