Skip to main content
Journal cover image

The Role of Adjuvant Therapy in Patients With Margin-Positive (R1) Esophagectomy: A National Analysis.

Publication ,  Journal Article
Raman, V; Jawitz, OK; Voigt, SL; Yang, C-FJ; D'Amico, TA; Harpole, DH
Published in: J Surg Res
May 2020

BACKGROUND: We performed a nationwide analysis to assess the impact of adjuvant therapy on survival after a microscopically margin-positive (R1) resection for esophageal cancer. METHODS: The National Cancer Database was used to identify patients with R1 resection for esophageal cancer (2004-2015). Patients were grouped by type of adjuvant therapy. Patients who had other margin status, M1 disease, neoadjuvant chemotherapy and radiation, missing survival, and no or unknown treatment were excluded. The primary outcome was overall survival. A 1:1 propensity score-matched sensitivity analysis was also performed comparing patients who received no adjuvant therapy with those who received adjuvant chemoradiation. RESULTS: Of 546 patients, 279 (51%) received adjuvant therapy and 267 (49%) did not. Patients receiving adjuvant therapy were more likely to be younger, have more advanced pathologic stage, have nonsquamous histology, and have shorter hospitalization. In multivariable analysis, adjuvant chemotherapy, radiation, and chemoradiation were all associated with improved survival compared with no adjuvant therapy. In a propensity score-matched analysis of 123 patient pairs, adjuvant chemoradiation was associated with improved survival compared with no adjuvant therapy (adjusted HR: 0.30; 95% CI: [0.22, 0.40]). CONCLUSIONS: Adjuvant therapy is associated with improved survival compared with no adjuvant therapy in patients with R1 resection for esophageal cancer even after adjustment for pathologic stage. Adjuvant therapy should be considered in patients with incompletely resected esophageal cancer in concordance with national guidelines.

Duke Scholars

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

May 2020

Volume

249

Start / End Page

82 / 90

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Surgery
  • Retrospective Studies
  • Propensity Score
  • Practice Guidelines as Topic
  • Neoplasm Staging
  • Middle Aged
  • Margins of Excision
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Raman, V., Jawitz, O. K., Voigt, S. L., Yang, C.-F., D’Amico, T. A., & Harpole, D. H. (2020). The Role of Adjuvant Therapy in Patients With Margin-Positive (R1) Esophagectomy: A National Analysis. J Surg Res, 249, 82–90. https://doi.org/10.1016/j.jss.2019.11.035
Raman, Vignesh, Oliver K. Jawitz, Soraya L. Voigt, Chi-Fu J. Yang, Thomas A. D’Amico, and David H. Harpole. “The Role of Adjuvant Therapy in Patients With Margin-Positive (R1) Esophagectomy: A National Analysis.J Surg Res 249 (May 2020): 82–90. https://doi.org/10.1016/j.jss.2019.11.035.
Raman V, Jawitz OK, Voigt SL, Yang C-FJ, D’Amico TA, Harpole DH. The Role of Adjuvant Therapy in Patients With Margin-Positive (R1) Esophagectomy: A National Analysis. J Surg Res. 2020 May;249:82–90.
Raman, Vignesh, et al. “The Role of Adjuvant Therapy in Patients With Margin-Positive (R1) Esophagectomy: A National Analysis.J Surg Res, vol. 249, May 2020, pp. 82–90. Pubmed, doi:10.1016/j.jss.2019.11.035.
Raman V, Jawitz OK, Voigt SL, Yang C-FJ, D’Amico TA, Harpole DH. The Role of Adjuvant Therapy in Patients With Margin-Positive (R1) Esophagectomy: A National Analysis. J Surg Res. 2020 May;249:82–90.
Journal cover image

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

May 2020

Volume

249

Start / End Page

82 / 90

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Surgery
  • Retrospective Studies
  • Propensity Score
  • Practice Guidelines as Topic
  • Neoplasm Staging
  • Middle Aged
  • Margins of Excision