Prognostic improvement of reexcision for positive resection margins in patients with advanced gastric cancer

• Published in: European journal of surgical oncology Vol. 39; no. 3; pp. 229 - 234
• Main Authors: Chen, J.-D, Yang, X.-P, Shen, J.-G, Hu, W.-X, Yuan, X.-M, Wang, L.-B
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2013
• Subjects: Aged; Analysis of Variance; Female; Frozen Sections; Gastrectomy; Gastric cancer; Hematology, Oncology and Palliative Medicine; Humans; Kaplan-Meier Estimate; Lymph Node Excision; Male; Middle Aged; Neoplasm Staging; Neoplasm, Residual - surgery; Prognosis; Proportional Hazards Models; Reexcision; Reoperation; Resection margin; Retrospective Studies; Sample Size; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Prognosis; Reexcision; Gastrectomy; Resection margin; Gastric cancer
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2012.08.004

Abstract Aim The aim of this study was to investigate the effect of reexcision for advanced gastric cancer (GC) with positive resection margins on prognosis and to identify the selection criteria for the reexcision of patients with positive margins. Patients and methods This was a retrospective study of 122 patients with positive margins who underwent potentially curative resection for locally advanced GC. The clinicopathological factors and survival among 50 patients who were reexcised to a negative resection margin (NR group) and 72 patients who were left with a positive resection margin (PR group) were compared using univariate and multivariate analyses. Results Median survival in the PR group was 18 months compared with 23 months in the NR group ( p  = 0.019). In the ≤pN2-category subset, the PR group had a significantly worse prognosis compared with the NR group (median survival of 25 months vs. 44 months; p  = 0.021). This difference was not observed in the pN3-category subset. In the univariate analysis, variables including pTNM stage, pN-category, and positive resection margin had adverse effects on OS among the entire population of 122 patients. A positive margin was confirmed as an independent prognostic factor for OS in the multivariate analysis. Conclusions The reexcision of a positive margin improves the prognosis of patients with advanced GC, especially in those paitents with ≤pN2-category disease and in patients undergoing D2 lymphadenectomy. Obtaining routine frozen sections of samples from the resection margin should be mandatory in the treatment of all GC patients undergoing potentially curative surgery.