Clinical impact of tumour involvement of the anastomotic doughnut in oesophagogastric cancer surgery.
Authors
Sillah, Abdul KarimGriffiths, Ewen A
Pritchard, S A
Swindell, Ric
West, Catharine M L
Page, Richard
Welch, I M
Affiliation
Department of Gastrointestinal Surgery, University Hospital of South Manchester NHS Foundation Trust, UK.Issue Date
2009-04
Metadata
Show full item recordAbstract
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.Citation
Clinical impact of tumour involvement of the anastomotic doughnut in oesophagogastric cancer surgery. 2009, 91 (3):195-200 Ann R Coll Surg EnglJournal
Annals of the Royal College of Surgeons of EnglandDOI
10.1308/003588409X359268PubMed ID
19220937Type
ArticleLanguage
enISSN
1478-7083ae974a485f413a2113503eed53cd6c53
10.1308/003588409X359268
Scopus Count
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