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• W2092193614 abstract "Background: Neo-adjuvant chemotherapy followed by oesophagectomy is standard of care for oesophageal cancer in the UK1. Patients with positive margins (R1) have poor prognosis and role of adjuvant (chemo)radiotherapy (CRT) is unclear.Aim: Evaluate outcome of patients undergoing oesophagectomy at a tertiary cancer centre, with special emphasis on outcome and management in the R1 subgroup.Standard:•R0 at the circumferential resection (CRM) and longitudinal margins should be achieved in >73% and >96% of patients respectively2.•Perioperative in-hospital mortality should be <2.9%2.•1 and 2 years overall survival (OS) of○ all patients should be >73% and >50% respectively1○ R1 patients should be >51% and >27% respectively3Methodology: All patients undergoing oesophagectomies between 6.7.2010-27.6.2012 at Churchill Hospital, Oxford were retrospectively identified. Case notes, pathology and, radiology reports, MDT proformas, chemotherapy and radiotherapy records were reviewed. Survival was determined from Kaplan-Meier curves and comparisons made with log-rank and Fisher’s exact tests.Results: 89 patients underwent oesophagectomies. 68 underwent NCT. At clinical staging, 57(84%) had ≥T3 disease and 52(76%) were node positive (TNM 6).R0 at CRM and longitudinal resection margins were achieved in 80% and 100% respectively. pCR rate was 7%. In-hospital mortality was 2.2%. One-year and 2-years OS of all patients were 86% and 67% respectively (median OS not reached); of patients receiving NCT – 90% and 68%; surgery only – 76% and 66%. R1 resection (n = 18) was associated with poor prognosis (1 yr OS 78% v 89%; 2 yr OS 38% v 74%, median OS 19 mo v not reached; p = 0.003). Local relapse was significantly lower in the 12 patients with R1 resection who underwent adjuvant chemo/radiotherapy (p = 0.043).Action Plan: The hospital meets current standards. A larger, possibly multi-centre audit is required to assess the role of CRT in patients with R1 resection and whether a formal randomized trial is warranted in this patient sub-group.Key references[1]. Ronellenfitsch U, Schwarzbach M, Hofheinz R, et al. Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data. Eur J Cancer 2013; 49(15): 3149–58. doi:10.1016/j.ejca.2013.05.029; 10.1016/j.ejca.2013.05.029.[2]. Chadwick G, Groene O, Cromwell D, Hardwick R, Riley S, Crosby T, Greenaway K. National Oesophago-gastric Cancer Audit – 2013, Annual report. 2013; Available at: http://www.hscic.gov.uk/catalogue/PUB11093/clin-audi-supp-prog-oeso-gast-2013-rep.pdf. Accessed January 26, 2013.[3]. Allum WH, Stenning SP, Bancewicz J, Clark PI, Langley RE. Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol 2009; 27(30): 5062–7. doi:10.1200/JCO.2009.22.2083; 10.1200/JCO.2009.22.2083. Background: Neo-adjuvant chemotherapy followed by oesophagectomy is standard of care for oesophageal cancer in the UK1. Patients with positive margins (R1) have poor prognosis and role of adjuvant (chemo)radiotherapy (CRT) is unclear. Aim: Evaluate outcome of patients undergoing oesophagectomy at a tertiary cancer centre, with special emphasis on outcome and management in the R1 subgroup. Standard:•R0 at the circumferential resection (CRM) and longitudinal margins should be achieved in >73% and >96% of patients respectively2.•Perioperative in-hospital mortality should be <2.9%2.•1 and 2 years overall survival (OS) of○ all patients should be >73% and >50% respectively1○ R1 patients should be >51% and >27% respectively3 Methodology: All patients undergoing oesophagectomies between 6.7.2010-27.6.2012 at Churchill Hospital, Oxford were retrospectively identified. Case notes, pathology and, radiology reports, MDT proformas, chemotherapy and radiotherapy records were reviewed. Survival was determined from Kaplan-Meier curves and comparisons made with log-rank and Fisher’s exact tests. Results: 89 patients underwent oesophagectomies. 68 underwent NCT. At clinical staging, 57(84%) had ≥T3 disease and 52(76%) were node positive (TNM 6). R0 at CRM and longitudinal resection margins were achieved in 80% and 100% respectively. pCR rate was 7%. In-hospital mortality was 2.2%. One-year and 2-years OS of all patients were 86% and 67% respectively (median OS not reached); of patients receiving NCT – 90% and 68%; surgery only – 76% and 66%. R1 resection (n = 18) was associated with poor prognosis (1 yr OS 78% v 89%; 2 yr OS 38% v 74%, median OS 19 mo v not reached; p = 0.003). Local relapse was significantly lower in the 12 patients with R1 resection who underwent adjuvant chemo/radiotherapy (p = 0.043). Action Plan: The hospital meets current standards. A larger, possibly multi-centre audit is required to assess the role of CRT in patients with R1 resection and whether a formal randomized trial is warranted in this patient sub-group. Key references [1]. Ronellenfitsch U, Schwarzbach M, Hofheinz R, et al. Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data. Eur J Cancer 2013; 49(15): 3149–58. doi:10.1016/j.ejca.2013.05.029; 10.1016/j.ejca.2013.05.029. [2]. Chadwick G, Groene O, Cromwell D, Hardwick R, Riley S, Crosby T, Greenaway K. National Oesophago-gastric Cancer Audit – 2013, Annual report. 2013; Available at: http://www.hscic.gov.uk/catalogue/PUB11093/clin-audi-supp-prog-oeso-gast-2013-rep.pdf. Accessed January 26, 2013. [3]. Allum WH, Stenning SP, Bancewicz J, Clark PI, Langley RE. Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol 2009; 27(30): 5062–7. doi:10.1200/JCO.2009.22.2083; 10.1200/JCO.2009.22.2083." @default.
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• W2092193614 date "2014-06-01" @default.
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• W2092193614 title "Audit on Outcome of Patients with Oesophageal Cancer following Oesophagectomy" @default.
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