OGC SO25 - Tumour Regression Grade (TRG) and Completeness of Resection in patients under esophagectomy for oesophageal Cancer

Abstract Background Oesophageal cancer, including squamous cell carcinoma (SCC) and adenocarcinoma, is challenging due to its aggressive nature and delayed presentation. Neoadjuvant chemotherapy aims to downstage the tumour thus aids in surgery and improves patient outcomes. Complete resection with tumour free resection margins is crucial for cure and survival. Understanding the relationship between tumour regression grade (TRG) and completeness of resection helps improve outcomes in patients with oesophageal cancer. Method This retrospective study was conducted over a period of 4 years (2019-2023). It included all patients over 18 years of age who underwent oesophagectomy for either squamous cell carcinoma (SCC) or adenocarcinoma following neoadjuvant chemotherapy. Tumour Regression Grade (TRG) was defined by the histological report while R1 resection was defined as any margin less than 1 mm. Statistical analysis was performed to evaluate the incidence of complete and incomplete resections across the various TRG groups. Results Study included 214 patients (178 males, 36 females) with a median age of 67 (31-82) years. Of the 214 patients, 201 (93.9%) had adenocarcinoma and 13 (6.1%) had SCC. Complete resection was achieved in 136 patients (63.6%), while 78 (36.4 %) had incomplete resections. TRG distribution in the complete resection group was-TRG 1 (97.6 %), TRG 2 (76.5 %), TRG 3 (67.2 %), TRG 4 (56.1 %), and TRG 5 (31.9 %). The Chi-Square test indicated significant associations between TRG and resection completeness (Chi-Square = 44.229, p < .001; Likelihood Ratio = 51.804, p < .001; Fisher's Exact Test p < .001). Conclusion The study demonstrates a significant correlation between higher TRG scores and incomplete resections in esophagectomy patients’ post-neoadjuvant chemotherapy. We conclude TRG is an important prognostic indicator for surgical outcomes in oesophageal cancer.