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CC BY 4.0 · Endoscopy
DOI: 10.1055/a-2272-9794
Original article

Vertical tumor-positive resection margins and the risk of residual neoplasia after endoscopic resection of Barrett’s neoplasia: a nationwide cohort with pathology reassessment

Laurelle van Tilburg  ‡
1   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Eva P. D. Verheij‡
2   Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
Steffi E. M. van de Ven 
1   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Sanne N. van Munster 
2   Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
Bas L. A. M. Weusten
3   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
4   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
,
Lorenza Alvarez Herrero
4   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
,
Wouter B. Nagengast
5   Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
,
Erik J. Schoon
6   Catharina Hospital, Catharina Cancer Institute, Department of Gastroenterology and Hepatology, Eindhoven, the Netherlands
7   GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
,
Alaa Alkhalaf
8   Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands
,
Jacques J. G. H. M. Bergman
2   Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
Roos E. Pouw
2   Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
Lindsey Oudijk
9   Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Sybren L. Meijer 
10   Department of Pathology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
,
Marnix Jansen
11   UCL Cancer Institute, University College London, London, United Kingdom
12   Department of Pathology, University College London Hospital, London, United Kingdom
,
Michail Doukas
9   Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Arjun D. Koch 
1   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
on behalf of the Dutch Barrett Expert Centers and the Dutch Barrett Expert Centers Study Group
› Author AffiliationsTrial Registration: Netherlands National Trial Register (http://www.trialregister.nl) Registration number (trial ID): NL7039 Type of study: Retrospective analysis of prospectively collected data
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Abstract

Background This study evaluated the proportion of patients with residual neoplasia after endoscopic resection (ER) for Barrett’s neoplasia with confirmed tumor-positive vertical resection margin (R1v).

Methods This retrospective cohort study included patients undergoing ER for Barrett’s neoplasia with histologically documented R1v since 2008 in the Dutch Barrett Expert Centers. We defined R1v as cancer cells touching vertical resection margins and Rx as nonassessable margins. Reassessment of R1v specimens was performed by experienced pathologists until consensus was reached regarding vertical margins.

Results 101/110 included patients had macroscopically complete resections (17 T1a, 84 T1b), and 99/101 (98%) ER specimens were histologically reassessed, with R1v confirmed in 74 patients (75%), Rx in 16%, and R0 in 9%. Presence/absence of residual neoplasia could be assessed in 66/74 patients during endoscopic reassessment (52) and/or in the surgical resection specimen (14), and 33/66 (50%) had residual neoplasia. Residual neoplasia detected during endoscopy was always endoscopically visible and biopsies from a normal-appearing ER scar did not detect additional neoplasia. Of 25 patients who underwent endoscopic follow-up (median 37 months [interquartile range 12–50]), 4 developed local recurrence (16.0%), all detected as visible abnormalities.

Conclusions After ER with R1v, 50% of patients had no residual neoplasia. Histological evaluation of ER margins appears challenging, as in this study 75% of documented R1v cases were confirmed during reassessment. Endoscopic reassessment 8–12 weeks after ER seems to accurately detect residual neoplasia and can help to determine the most appropriate strategy for patients with R1v.

Tables 1 s–6 s, Fig. 1 s



Publication History

Received: 11 October 2023

Accepted after revision: 20 February 2024

Accepted Manuscript online:
20 February 2024

Article published online:
05 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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