Prognostic Significance of Positive Circumferential Resection Margin in Esophageal Cancer: A Systematic Review and Meta-Analysis

Background. To assess the prognostic significance of positive circumferential resection margin on overall survival in patients with esophageal cancer, a systematic review and meta-analysis was performed. Methods. Studies were identified from PubMed, EMBASE, and Web of Science. Survival data were extracted from eligible studies to compare overall survival in patients with a positive circumferential resection margin with patients having a negative circumferential resection margin according to the Royal College of Pathologists (RCP) criteria and the College of American Pathologists (CAP) criteria. Survival data were pooled with hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs). A random-effects model meta-analysis on overall survival was performed. Results. The pooled HRs for survival were 1.510 (95% CI, 1.329-1.717; p < 0.001) and 2.053 (95% CI, 1.597-2.638; p < 0.001) according to the RCP and CAP criteria, respectively. Positive circumferential resection margin was associated with worse survival in patients with T3 stage disease according to the RCP (HR, 1.381; 95% CI, 1.028-1.584; p = 0.001) and CAP (HR, 2.457; 95% CI, 1.902-3.175; p < 0.001) criteria, respectively. Positive circumferential resection margin was associated with worse survival in patients receiving neoadjuvant therapy according to the RCP (HR, 1.676; 95% CI, 1.023-2.744; p = 0.040) and CAP (HR, 1.847; 95% CI, 1.226-2.78; p = 0.003) criteria, respectively. Conclusions. Positive circumferential resection margin is associated with poor prognosis in patients with esophageal cancer, particularly in patients with T3 stage disease and patients receiving neoadjuvant therapy. (C) 2014 by The Society of Thoracic Surgeons