Treatment of esophageal cancer: surgical outcomes of 335 cases operated in a single center

ABSTRACT Objectives: the surgical approach persists as the main treatment for esophageal cancer. This study compares the patients of the same institution over time at three different times. Methods: this is a retrospective, observational, descriptive study comparing the surgical outcomes obtained by the Division of Surgical Oncology of Erasto Gaertner Hospital. The sample was divided into Period 1 (1987-1997), Period 2 (1998-2003) and Period 3 (2007-2015). Survival rates and disease-free survival were estimated by the Kaplan-Maier method. Survival predictors were identified with Cox regression. ANOVA test was used for comparison between groups. Data were analyzed with SPSS 25.0 and STATA 16, and p<0.05 was considered statistically significant. Results: a total of 335 patients underwent esophagectomy or esophagogastrectomy. When the clinical characteristics of the 3 groups were compared, there was no statistically significant difference. Neoadjuvance was significantly higher in Period 3 (55.4% of patients). We found a histological change in the diagnosis over time, with a significant increase in adenocarcinoma. Morbidity and mortality rates were higher in Period 3. The main complications were pulmonary and anastomotic fistulas. Overall survival in 5 years increased over time, reaching 59.7% in Period 3. Conclusions: better neoadjuvant treatment contributed to increase the global survival of patients, despite greater rate of immediate complications to surgery.

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National trends in local excision and esophagectomy for cT1N0 esophageal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.62 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 62-62 ◽

Cited By ~ 1

Author(s):

Emily C. Sturm ◽

Whitney Zahnd ◽

John D. Mellinger ◽

Sabha Ganai

Keyword(s):

Esophageal Cancer ◽

Regression Analysis ◽

Local Excision ◽

Clinical Characteristics ◽

Cox Regression ◽

Chi Square ◽

Cox Regression Analysis ◽

Significant Difference ◽

Chi Square Analysis ◽

Over Time

62 Background: Esophageal cancer management has evolved due to improvements in staging and treatment strategies. Endoscopic local excision presents an attractive option for definitive management of T1 cancers, avoiding the morbidity of esophagectomy. We hypothesized that for cT1N0 cancers, patients who underwent local excision would have lower survival compared to esophagectomy due to potential discordant staging. Methods: The National Cancer Database was queried for esophageal squamous cell carcinoma (SCC) and adenocarcinoma (AC) with AJCC T1N0 clinical stage who underwent local excision (n = 1625) or esophagectomy (n = 3255) between 1998 and 2012. Chi-square analysis was used to compare demographic and clinical characteristics by procedure. Chi-square trend analysis was performed to assess trends in procedure type over time. Cox Regression analysis was performed to assess survival by procedure controlling for demographic and clinical characteristics. Results: Between 1998 and 2012, the proportion of patients who underwent local excision increased from 12% to 50% for all patients (p < 0.001); from 17% to 40% for SCC patients (p < 0.001); and from 9% to 51% for AC patients (p < 0.001). Surgical procedure varied significantly by demographic, socioeconomic status, facility, and tumor-related factors. 65% of cT1N0 cancers had concordant clinical and pathological staging after esophagectomy, with 11% having positive nodal disease; 44% were concordant after local excision. While no significant difference was seen in unadjusted survival, adjusted Cox Regression analysis indicated worse survival after esophagectomy compared to local excision for all cases (HR 1.67; 95% CI, 1.40-2.00) and for ACs with concordant staging (HR 1.54; 95% CI, 1.11-2.14). Conclusions: Local excision for cT1N0 esophageal cancer has increased over time. Staging concordance for esophagectomy is seen in two-thirds of cases. Contrary to our hypothesis, patients undergoing local excision for T1N0 cancers have better overall survival than those undergoing esophagectomy, which may reflect early differences in mortality and/or selection bias. As this study was unable to distinguish T1a from T1b, further analysis is warranted.

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Adjuvant chemotherapy of cisplatin, 5-fluorouracil (5-FU) plus leucovorin (LV) for esophageal cancer: A case-matched cohort study in east china

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15135 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15135-15135

Author(s):

J. Zhang ◽

J. Xiang ◽

Y. Zhang ◽

X. Zhou

Keyword(s):

Esophageal Cancer ◽

Adjuvant Chemotherapy ◽

Randomized Clinical Trials ◽

Cox Regression ◽

Univariate Analysis ◽

Disease Free Survival ◽

Treatment Result ◽

Chemotherapy Group ◽

Study Results ◽

Significant Difference

15135 Background: There are very few prospective randomized clinical trials regarding the adjuvant chemotherapy of esophageal cancer. This study is to compare the survival between the patients who received adjuvant chemotherapy of cisplatin, 5-Fluorouracil (5-FU) plus leucovorin (LV) and those who did not. Methods: Between 1998 and 2004, 90 esophageal cancer patients with adjuvant chemotherapy, and clinic-pathologically well- matched 180 patients without chemotherapy, were included in this study. Results: There was no significant difference for disease-free-survival and overall-survival in stage I (P=0.59&p=0.59), stage II (P=0.2778&P=0.2778) and stage III patients (P=0.695 &P=0.8667) between observation group and chemotherapy group. Chemotherapy was most effective for the patients who had metastasis in cervical and /or celiac lymph node (IVa subgroup) by both univariate analysis and multivariate COX regression model. 1 and 3-year DFS and OS are significantly better than those who did not receive the chemotherapy(P= 0.038,and 0.01, respectively). Among the factors evaluated by immunohistochemical staining, Bcl-2 expression in the primary tumor was a worse prognostic factor, and was more predictive in adjuvant chemotherapy group than no chemotherapy group. Conclusions: Adjuvant chemotherapy significantly improved the treatment result of stage IVa patients. Bcl-2 could be potentially used to analyze the prognosis and guild the adjuvant treatment in esophageal cancer. No significant financial relationships to disclose.

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Prognostic value of the circumferential resection margin after neoadjuvant treatment in esophageal cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.147 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 147-147

Author(s):

Jan-Binne Hulshoff ◽

Zohra Faiz ◽

Justin Kendrick Smit ◽

Gursah Kats-Ugurlu ◽

Johannes Burgerhof ◽

...

Keyword(s):

Esophageal Cancer ◽

Prognostic Factors ◽

Cox Regression ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Neoadjuvant Chemoradiotherapy ◽

Clinical Manifestations ◽

Disease Free Survival ◽

Tumor Length ◽

Surgery Group

147 Background: Involvement of the circumferential margin (CRM) is an important factor in esophageal cancer (EC) patients. CRM definitions are commonly based on the College of American Pathologists (CAP) at 0 mm and the Royal College of Pathologists (RCP) at >1 mm. We evaluated which CRM definition is useful in current practice with neoadjuvant chemoradiotherapy (CRT) and whether the CRM cut-off value differs after CRT. Methods: We prospectively included 209 patients (104 with CRT) with locally advanced EC (stage II-III), who underwent radical transthoracic esophagectomy. Patients were followed for at least 2 years after surgery or until death. Patients with <1 mm longitudinal resection margins were excluded. Cancer related death was scored as event and death of other causes as end of follow-up (median 27: IQR 14.0 - 42.8 months). CRMs were measured in tenths of millimetres by experienced pathologists. Pathologic proven tumor regrowth, unequivocal radiologic suspicion or obvious clinical manifestations were marked as recurrence. Prognostic factors with a P<0.1 in univariate analyses were incorporated in multivariate Cox-regression analyses in which both CRM definitions were assessed separately. In an explorative analyses the CRM cut-off values in the surgery-only and CRT group for 2-year disease free survival (DFS) was assessed using CRM between 0-1.5 mm in the Cox-regression model. Results: Independent prognostic factors for 2-year DFS (P<0.05) in the study group were: tumor length (>5cm), >0.2 L/N+ ratio, angioinvasion and CAP R0. In the surgery group; tumor length, >4 N+, angioinvasion and CAP R0 were independent prognostic factors (P <0.05). In the CRT group only pN stage (P<0.01) was independent prognostic for 2-year DFS. The CRM cut-off value was significant at 0.2-0.3 mm for the surgery and CRT group, respectively. Conclusions: The CAP value was only independent prognostic for 2-year DFS in the surgery group. The CRM cut-off value was significant at 0.2 and 0.3 mm in the surgery and CRT group, respectively.

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Treatment of colorectal cancer in Armenia: A retrospective hospital-based study from a developing world.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16099 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16099-e16099

Author(s):

Samvel Bardakhchyan ◽

Sergo Mkhitaryan ◽

Davit Zohrabyan ◽

Liana Safaryan ◽

Armen Avagyan ◽

...

Keyword(s):

Colorectal Cancer ◽

Adjuvant Chemotherapy ◽

Median Survival ◽

Cox Regression ◽

Survival Rates ◽

Disease Free Survival ◽

Rectum Cancer ◽

Cox Regression Analysis ◽

Stage 4 ◽

Significant Difference

e16099 Background: In Armenia colorectal cancer (CRC) is on the third place by incidence. Every year around 700 new cases are diagnosed with 60% diagnosed in 3rd and 4th stages. Methods: For this retrospective hospital-based study we have collected data from two main oncology centers in Armenia: National Oncology Center and Muratsan Hospital Complex of Yerevan state medical university. The information about patients with CRC who were treated at these two centers during 01/01/2010 - 07/01/2018 period was collected from the medical records. Results: 602 patients with CRC treated during mentioned period in these two hospitals were involved in final analysis. From them 51.8% were female. Median age at diagnosis was 58. Median follow up time was 37 months (range 3-207). 26.1% had right sided, 30.9% left sided and 43.0% rectum cancer. 8.6% of patients had stage 1, 32.9% stage 2, 38.0% stage 3, 17.6% stage 4 CRC and for 2.7% patients stage was unknown. The median survival was not reached for the entire cohort ( > 37 months). Median survival was > 66.5 months for 1st, > 48.5 months for 2nd, > 35 months for 3rd and 19 months for 4th stages. Tumor stage, grade and histology were the main independent prognostic factors by univariate and multivariate Cox regression analysis. For stage 2 CRC patients (198) we found significant difference regarding overall survival (OS) (p = 0.024) and disease free survival (DFS) (p = 0.006) for those who received adjuvant chemotherapy after surgery compared to those who didn’t receive adjuvant chemotherapy. For stage 2 and 3 rectum cancer patients, our study failed to show OS (2nd stage: p = 0.961; 3rd stage: p = 0.348) or DFS (2nd stage: p = 0.719; 3rd stage: p = 0.983) advantage for those who received radiotherapy (RT) compared with those who didn’t receive RT. In our study population 28.3% of stage 4 patients received chemotherapy combined with Bevacizumab while 70% were treated with chemotherapy only. Median OS between these two groups wasn’t significantly different (21 months in Chemo+Bevacizumab group and 18.5 months in chemo only group (p = 0.382)). 3 and 5-year survival rates were 62.9% and 51.8% for all stages combined and 79.7% and 68.5% for stages 1-2, 62.5% and 48.4% for stage 3, 24.4% and 17% for stage 4 respectively. Conclusions: As seen from our results our survival rates are inferior compared to that of developed world. The reasons for that could be compromise in surgery and RT, poor pathological assessment, unavailability of some molecular markers, poor availability of new targeted drugs and absence of national treatment guidelines.

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Impact of Tumor LINE-1 Methylation Level and Neoadjuvant Treatment and Its Association with Colorectal Cancer Survival

Journal of Personalized Medicine ◽

10.3390/jpm10040219 ◽

2020 ◽

Vol 10 (4) ◽

pp. 219

Author(s):

Hatim Boughanem ◽

Gracia María Martin-Nuñez ◽

Esperanza Torres ◽

Isabel Arranz-Salas ◽

Julia Alcaide ◽

...

Keyword(s):

Colorectal Cancer ◽

Cox Regression ◽

Interactive Effect ◽

Survival Rates ◽

Neoadjuvant Treatment ◽

Disease Free Survival ◽

Pathological Features ◽

Tumor Line ◽

Free Survival ◽

Disease Free

Recent studies suggest that long-interspersed nucleotide element-1 (LINE-1) hypomethylation is commonly found in colorectal cancer (CRC), and is associated with worse prognosis. However, the utility of LINE-1 methylation on the prognosis of CRC is still controversial, and may be due to the fact that some clinical and pathological features may affect LINE-1 methylation. Thus, the aim of this study was to assess the prognostic value of tumor LINE-1 methylation in CRC, through their association with the CRC clinical and pathological characteristics. Survival of sixty-seven CRC patients was evaluated according to the median of tumor LINE-1 methylation, as well as pathological and oncological variables. We also studied the association between LINE-1 methylation and pathological features, and finally, we assessed the overall and disease-free survival of LINE1 methylation, stratified by neoadjuvant treatment and further checked by multivariate Cox regression to assess the statistical interactions. LINE-1 was hypomethylated in the CRC tumor with respect to the tumor adjacent-free area (p < 0.05), without association with any other clinical and oncological features, nor with overall and disease-free survival rates for CRC. Relevantly, in neoadjuvant treatment, LINE-1 methylation was associated with survival rates. Thus, disease-free and overall survival rates of treated CRC patients were worse in the hypomethylated LINE-1 tumors than those with normal LINE-1 methylation (p = 0.004 and 0.0049, respectively). Indeed, LINE-1 was hypermethylated more in the treated patients than in the non-treated patients (p < 0.05). The present study showed that tumor LINE-1 hypomethylation was associated with worse survival rates in only treated patients. Our data suggest an interactive effect of neoadjuvant treatment and tumor LINE-1 methylation, which could be a specific-tissue biomarker to predict survival of the treated patients, and help to personalize treatment in CRC.

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Differences in the outcomes of adjuvant chemotherapy for colon cancer prescribed by physicians in different disciplines: a population-based study in Taiwan

BMJ Open ◽

10.1136/bmjopen-2017-021341 ◽

2018 ◽

Vol 8 (12) ◽

pp. e021341

Author(s):

Cheng-I Hsieh ◽

Raymond Nien-Chen Kuo ◽

Chun-Chieh Liang ◽

Hsin-Yun Tsai ◽

Kuo-Piao Chung

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Cox Regression ◽

Surgical Margin ◽

Disease Free Survival ◽

Disease Stage ◽

Multiple Primary Cancers ◽

Positive Surgical Margin ◽

Recurrence Rates ◽

Significant Difference

ObjectivesOne feature unique to the Taiwanese healthcare system is the ability of physicians other than oncologists to prescribe systemic chemotherapy. This study investigated whether the care paths implemented by oncologists and non-oncologists differ with regard to patient outcomes.SettingData from the Taiwan Cancer Registry and National Health Insurance Database were linked to identify patients with colon cancer who underwent colectomy as first treatment within 3 months of diagnosis and adjuvant chemotherapy between 2005 and 2009.Participants and methodsPostoperative patients who underwent adjuvant chemotherapy were included in this study. The exclusion criteria included patients with stage IV disease, a positive surgical margin and early disease recurrence. Among the patients presenting with multiple primary cancers, we also excluded patients who were diagnosed with colon cancer but for whom this was not the first primary cancer. The variables included sex, age, comorbidities, disease stage, chemotherapy cycle and changes in treatment regimen as well as the specialty of treatment providers and their case volume. Cox regression models and Kaplan-Meier analysis were used to examine differences in outcomes in the matched cohorts.ResultsWe examined 3534 patients who were prescribed adjuvant chemotherapy by physicians from different disciplines. In terms of 5-year disease-free survival, no significant difference was observed between the groups of oncologists or surgeons among patients with stage II (90.02%vs88.99%) or stage III (77.64%vs79.99%) diseases. Patients who were subjected to changes in their chemotherapy regimens presented recurrence rates higher than those who were not.ConclusionsThe discipline of practitioners is seldom taken into account in most series. This is the first study to provide empirical evidence demonstrating that the outcomes of patients with colon cancer do not depend on the treatment path, as long as the selection criteria for adjuvant chemotherapy is appropriate. Further study will be required before making any further conclusions.

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The prognosis of hepatoid adenocarcinoma of the stomach: a propensity score-based analysis

10.21203/rs.3.rs-19206/v2 ◽

2020 ◽

Author(s):

Kai Zhou ◽

Anqiang Wang ◽

Sheng Ao ◽

Jiahui Chen ◽

Ke Ji ◽

...

Keyword(s):

Propensity Score ◽

Cox Regression ◽

Radical Surgery ◽

Survival Rates ◽

Cancer Type ◽

Radical Gastrectomy ◽

Hepatoid Adenocarcinoma ◽

Kaplan Meier ◽

Significant Difference ◽

Propensity Matching

Abstract Background : To investigate whether there is a distinct difference in prognosis between hepatoid adenocarcinoma of the stomach ( HAS) and non-hepatoid adenocarcinoma of the stomach (non-HAS) and whether HAS can benefit from radical surgery. Methods : We retrospectively reviewed 722 patients with non-HAS and 75 patients with HAS who underwent radical gastrectomy between 3 November 2009 and 17 December 2018. Propensity score matching (PSM) analysis was used to eliminate the bias among the patients in our study. The relationships between gastric cancer type and overall survival (OS) were evaluated by the Kaplan-Meier method and Cox regression. Results : Our data demonstrate that there was no statistically significant difference in the OS between HAS and non-HAS {K-M, P=log rank (Mantel-Cox), (before PSM P=0.397); (1:1 PSM P=0.345); (1:2 PSM P=0.195)}. Moreover, there were no significant differences in the 1-, 2-, or 3-year survival rates between patients with non-HAS and patients with HAS (before propensity matching, after 1:1 propensity matching, and after 1:2 propensity matching). Conclusion : HAS was generally considered to be an aggressive gastric neoplasm, but its prognosis may not be as unsatisfactory as previously believed.

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Efficacy and Safety of Albumin-Bound Paclitaxel Compared to Docetaxel as Neoadjuvant Chemotherapy for HER2-Negative Breast Cancer

Frontiers in Oncology ◽

10.3389/fonc.2021.760655 ◽

2022 ◽

Vol 11 ◽

Author(s):

Zhi-Dong Lv ◽

Hong-Ming Song ◽

Zhao-He Niu ◽

Gang Nie ◽

Shuai Zheng ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Neoadjuvant Treatment ◽

Disease Free Survival ◽

Lymph Node Status ◽

Efficacy And Safety ◽

Significant Difference ◽

Paclitaxel Group ◽

Docetaxel Group

BackgroundNanoparticle albumin-bound paclitaxel (nab-paclitaxel) as neoadjuvant chemotherapy (NAC) for breast cancer remains controversial. We conducted a retrospective study to compare the efficacy and safety of nab-paclitaxel with those of docetaxel as neoadjuvant regimens for HER2-negative breast cancer.MethodsIn this retrospective analysis, a total of 159 HER2-negative breast cancer patients who had undergone operation after NAC were consecutively analyzed from May 2016 to April 2018. Patients were classified into the nab-paclitaxel group (n = 79, nab-paclitaxel 260 mg/m2, epirubicin 75 mg/m2, and cyclophosphamide 500 mg/m2) and the docetaxel group (n = 80, docetaxel 75 mg/m2, epirubicin 75 mg/m2, and cyclophosphamide 500 mg/m2) according to the drug they received for neoadjuvant treatment. The efficacy and adverse events were evaluated in the two groups.ResultsThe pathological complete response (pCR)(ypT0/isN0) rate was significantly higher in the nab-paclitaxel group than in the docetaxel group (36.71% vs 20.00%; P = 0.031). The multivariate analysis revealed that therapeutic drugs, lymph node status, and tumor subtype were the most significant factor influencing treatment outcome. At a median follow-up of 47 months, disease-free survival (DFS) was not significantly different in those assigned to nab-paclitaxel compared with docetaxel (82.28% vs 76.25%; P = 0.331). The incidence of peripheral sensory neuropathy in the nab-paclitaxel group was higher than that in the docetaxel group (60.76% vs 36.25%; P = 0.008), while the incidence of arthralgia was observed more frequently in the docetaxel group (57.50% vs 39.97%; P = 0.047).ConclusionsCompared with docetaxel, nab-paclitaxel achieved a higher pCR rate, especially those patients with triple-negative breast cancer or lymph node negative breast cancer. However, there was no significant difference in DFS between the two groups. This study provides a valuable reference for the management of patients with HER2-negative breast cancer.

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Role of 18F-PET-CT to Predict Pathological Response After Neoadjuvant Treatment of Rectal Cancer

10.21203/rs.3.rs-143636/v1 ◽

2021 ◽

Author(s):

Riccardo Caruso ◽

Emilio Vicente ◽

Yolanda Quijano ◽

Hipolito Duran ◽

Isabel Fabra ◽

...

Keyword(s):

Rectal Cancer ◽

Fdg Pet ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Standardized Uptake Value ◽

Disease Free Survival ◽

Pet Ct ◽

Significant Difference ◽

18F Fdg ◽

Fdg Pet Ct

Abstract Objectives: Neoadjuvant radiochemotherapy (nCRT) is universally considered to be a valid treatment to achieve downstaging, improve local disease control and obtain better resectability in locally advanced rectal cancer (LARC). The aim of this study is to correlate the change in tumor 18F -FDG PET-CT standardized uptake value (SUV) before and after nCRT, in order to obtain an early prediction of pathologic response (pR) achieved in patients with LARC.Data description: We performed a retrospective analysis of patients with LARC diagnosis who underwent curative resection. All patients received nCRT and surgical treatment was carried after 8/12th. All patients underwent a baseline 18F -FDG PET-CT scan within the week prior to the initiation of the treatment (PET-CT SUV1) and a second scan (PET-C T SUV2) within six weeks of the completion of nCRT. Furthermore, we evaluated the prognostic value of 18F -FDG PET-CT in terms of disease free survival (DFS) and overall survival (OS) in patients with LARC.A total of 133 patients with LARC were included in the study. Patients were divided in two groups according to the TRG (tumor regression grade): 107 (80%) as Responders group (TRG0-TRG1) and 26 (25%) as the No-Responders group (TRG2-TRG3). We obtained a significant difference in Δ%SUV between the two different groups responders vs no responders (p<0.012).The results of this analysis have shown that 18F-FDG PET-CT may be an indicator in order to evaluate the pR to nCRT in patients with LARC. The decrease in 18F-FDG PET-CT uptake in the primary tumor may offer primary information in order to early identify those patients more likely to obtain a pCR to nCRT and predict those unlikely to regress significantly.

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O30 NON-RADICAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER; A NATIONWIDE STUDY ON INCIDENCE, RISK FACTORS AND OUTCOMES IN SWEDEN

Diseases of the Esophagus ◽

10.1093/dote/doz092.30 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

David Edholm ◽

Petter Hollertz ◽

Per Sandström ◽

Bergthor Björnsson ◽

Dennis Björk ◽

...

Keyword(s):

Risk Factors ◽

Esophageal Cancer ◽

Cox Regression ◽

Regional Lymph Node ◽

Neoadjuvant Treatment ◽

Resected Specimen ◽

Radical Esophagectomy ◽

Term Survival ◽

R1 Resection ◽

Independent Risk Factors

Abstract Aim To identify potential risk factors for a microscopically non-radical esophageal cancer resection (R1) and investigate how such a resection affects long-term survival. Background & Methods Esophageal cancer resections that are considered R1 have been associated with worse survival. The Swedish National Register for Esophageal and Gastric Cancer includes information on all esophageal cancer resections in Sweden. All patients having undergone esophageal resection with curative intent 2006-2017 were included. Risk factors for R1 resection were assessed through logistic regression. Factors predicting five-year survival were assessed through Cox-regression, adjusted for T-stage, N-stage, age and R-status. Results The study included 1,504 patients. The margins were microscopically involved in 146 patients (10%). Of these the circumferential margin was involved in 115 (8%). The proximal margin was involved in 55 patients (4%) and the distal in 30 (2%). In 54 (4%) specimens two margins were involved. Independent risk factors for R1-resection were absence of neoadjuvant treatment and clinical T3 stage or higher. The 5-year survival for the entire cohort was 41%, but only 19% for those with an R1 resection. Independent risk factors for death within 5-year from resection were regional lymph node metastasis (Hazard Ratio (HR) 2.6 (95% CI 2.2-3.1), histopathological stage T3 or higher (HR 1.2 95% CI 1.1-1.5), age above 60 years and R1-resection (HR 1.6 95% CI 1.4-2.0) Conclusion Involved margin in the resected specimen is an independent risk factor predicting worse 5-year survival. Besides striving for adequate surgical margins, the rate of R1-resections could be decreased through neoadjuvant treatment in fit patients.

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