Clinical impact of tumour involvement of the anastomotic doughnut in oesophagogastric cancer surgery.

2.50
Hdl Handle:
http://hdl.handle.net/10541/69735
Title:
Clinical impact of tumour involvement of the anastomotic doughnut in oesophagogastric cancer surgery.
Authors:
Sillah, Abdul Karim; Griffiths, Ewen A; Pritchard, S A; Swindell, Ric; West, Catharine M L; Page, Richard; Welch, I M
Abstract:
INTRODUCTION: Published colorectal cancer surgery data suggest no role for the analysis of the anastomotic doughnuts following anterior resection. The usefulness of routine histological analysis of the upper gastrointestinal doughnut is not clear. Our study assessed the impact of cancer involvement of the doughnut on clinical practice. Factors associated with doughnut involvement and the effect on patients' survival were also analysed. PATIENTS AND METHODS: The clinicopathological details of 462 patients who underwent potentially curative oesophagogastrectomy for cancer with a stapled anastomosis between 1994 and 2006 in two specialist centres were retrospectively analysed. Univariate, multivariate and survival analyses were carried out. RESULTS: Approximately 5% of doughnuts (22 of 462) were histologically involved with cancer. Microscopic involvement of the proximal resection margin, local lymph node metastasis and lymphatic invasion within the main resected specimen were independently associated with doughnut involvement (all P < 0.05). However, these three factors taken together failed to predict doughnut involvement. Doughnut involvement was an independent adverse prognostic factor for overall survival (P = 0.0013). CONCLUSIONS: In contrast to findings in colorectal surgery, doughnut involvement with cancer appears to have useful prognostic information following oesophagogastrectomy. Routine histological analysis of upper gastrointestinal doughnuts is justified. Doughnut involvement could potentially strengthen the indications for adjuvant therapy in the future.
Affiliation:
Department of Gastrointestinal Surgery, University Hospital of South Manchester NHS Foundation Trust, UK.
Citation:
Clinical impact of tumour involvement of the anastomotic doughnut in oesophagogastric cancer surgery. 2009, 91 (3):195-200 Ann R Coll Surg Engl
Journal:
Annals of the Royal College of Surgeons of England
Issue Date:
Apr-2009
URI:
http://hdl.handle.net/10541/69735
DOI:
10.1308/003588409X359268
PubMed ID:
19220937
Type:
Article
Language:
en
ISSN:
1478-7083
Appears in Collections:
All Christie Publications ; Academic Department of Radiation Oncology - ADRO

Full metadata record

DC FieldValue Language
dc.contributor.authorSillah, Abdul Karim-
dc.contributor.authorGriffiths, Ewen A-
dc.contributor.authorPritchard, S A-
dc.contributor.authorSwindell, Ric-
dc.contributor.authorWest, Catharine M L-
dc.contributor.authorPage, Richard-
dc.contributor.authorWelch, I M-
dc.date.accessioned2009-06-04T14:35:32Z-
dc.date.available2009-06-04T14:35:32Z-
dc.date.issued2009-04-
dc.identifier.citationClinical impact of tumour involvement of the anastomotic doughnut in oesophagogastric cancer surgery. 2009, 91 (3):195-200 Ann R Coll Surg Englen
dc.identifier.issn1478-7083-
dc.identifier.pmid19220937-
dc.identifier.doi10.1308/003588409X359268-
dc.identifier.urihttp://hdl.handle.net/10541/69735-
dc.description.abstractINTRODUCTION: Published colorectal cancer surgery data suggest no role for the analysis of the anastomotic doughnuts following anterior resection. The usefulness of routine histological analysis of the upper gastrointestinal doughnut is not clear. Our study assessed the impact of cancer involvement of the doughnut on clinical practice. Factors associated with doughnut involvement and the effect on patients' survival were also analysed. PATIENTS AND METHODS: The clinicopathological details of 462 patients who underwent potentially curative oesophagogastrectomy for cancer with a stapled anastomosis between 1994 and 2006 in two specialist centres were retrospectively analysed. Univariate, multivariate and survival analyses were carried out. RESULTS: Approximately 5% of doughnuts (22 of 462) were histologically involved with cancer. Microscopic involvement of the proximal resection margin, local lymph node metastasis and lymphatic invasion within the main resected specimen were independently associated with doughnut involvement (all P < 0.05). However, these three factors taken together failed to predict doughnut involvement. Doughnut involvement was an independent adverse prognostic factor for overall survival (P = 0.0013). CONCLUSIONS: In contrast to findings in colorectal surgery, doughnut involvement with cancer appears to have useful prognostic information following oesophagogastrectomy. Routine histological analysis of upper gastrointestinal doughnuts is justified. Doughnut involvement could potentially strengthen the indications for adjuvant therapy in the future.en
dc.language.isoenen
dc.subjectOesophageal Canceren
dc.subjectAnastomotic Doughnuten
dc.subjectHistologyen
dc.titleClinical impact of tumour involvement of the anastomotic doughnut in oesophagogastric cancer surgery.en
dc.typeArticleen
dc.contributor.departmentDepartment of Gastrointestinal Surgery, University Hospital of South Manchester NHS Foundation Trust, UK.en
dc.identifier.journalAnnals of the Royal College of Surgeons of Englanden

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