Proximal margin length with transhiatal gastrectomy for Siewert type II and III adenocarcinomas of the oesophagogastric junction

Background A gross proximal oesophageal margin greater than 5cm is considered to be necessary for curative surgery of adenocarcinoma of the oesophagogastric junction. This study investigated whether a shorter proximal margin might suffice in the context of total gastrectomy for Siewert type II and III tumours. Methods The gross proximal margin was measured on stretched specimens just after resection. Relationships between gross proximal margin lengths and clinicopathological features were investigated in patients with Siewert type II and III adenocarcinoma of the oesophagogastric junction treated by R0-1 surgical resection. For survival analyses, only patients who had undergone R0 resection for pathological (p) T2-4N0-3M0 tumour via a transhiatal approach were evaluated. Results Of the 140 patients, 120 had a total gastrectomy. Two patients (1 center dot 4 per cent) had histologically positive proximal margins and another two (1 center dot 4 per cent) developed anastomotic recurrence. Of 100 patients with pT2-4N0-3M0 tumours who underwent gastrectomy via a transhiatal approach, those with gross proximal margins larger than 20mm appeared to have better survival than those with shorter margins (P = 0 center dot 027). Multivariable analysis demonstrated that a gross proximal margin of 20mm or less was an independent prognostic factor (hazard ratio (HR) 3 center dot 56, 95 per cent confidence interval 1 center dot 39 to 9 center dot 14; P = 0 center dot 008), as was pathological node status (HR 1 center dot 76, 1 center dot 08 to 2 center dot 86; P = 0 center dot 024). Conclusion Gross proximal margin lengths of more than 20mm in resected specimens seem satisfactory for patients with type II and III adenocarcinoma of the oesophagogastric junction treated by transhiatal gastrectomy.