This study identifies the contact angle on preoperative CT images as a predictor for resection margins in ycT3 esophageal cancer patients, impacting surgical decision-making.

• Patients with positive resection margins had a contact angle of 130° vs. 93° for negative margins (p=0.0002).
• A contact angle ≥125° predicts positive margins with a sensitivity of 63% and specificity of 87% (AUC 0.76).
• Poorer prognosis is linked to CA ≥125°, with median survival of 11 months compared to 33 months for CA <125° (HR 1.83; p=0.03).

Consider using contact angle measurements to guide surgical strategies and patient counseling.