Association of Positive Transection Margins with Gastric Cancer Survival and Local Recurrence

Abstract

Positive resection margin is associated with advanced AJCC stage and aggressive tumor biology but remains an independent predictor of worse survival. The significance of a positive margin in gastric cancer is confined to patients with nontransmural disease and/or limited nodal involvement.

Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study

“…Sun et al [3] found that locoregional relapse in patients with positive RMs was more frequent than distant or peritoneal relapse, and that it was more frequent than in negative RM patients, as expected. In contrast, Wang et al [14] and Bickenbach et al [20] showed that the main recurrence pattern in R1 resection patients was peritoneal rather than locoregional. This finding may indicate that positive RM patients generally have a more advanced and more aggressive disease [20], whose systemic impact can mask the still present locoregional effects.…”

“…In contrast, Wang et al [14] and Bickenbach et al [20] showed that the main recurrence pattern in R1 resection patients was peritoneal rather than locoregional. This finding may indicate that positive RM patients generally have a more advanced and more aggressive disease [20], whose systemic impact can mask the still present locoregional effects. In addition, in our study we found that patients with positive RMs had clinicopathological features significantly more advanced and more aggressive than those of R0 resection patients, especially concerning T category, N category, grading, and Lauren pattern.…”

“…Lee et al [23] showed that the OS rate and the recurrence rate are not changed if R0 resection is achieved by performing additional resection for positive RMs. Other authors, by contrast, found that surgical re-excision of infiltrated margin has a prognostic benefit only when disease extension is limited, as in case of limited nodal involvement [20,24] or nontrasmural disease [20], and should therefore be attempted only in such cases.…”

“…For this reason, several studies have been performed to identify risk factors associated with RM involvement, and a systematic review of this topic has been published recently [28]. According to the different studies, T category [2,3,14,20], N category [2,3,14,20], tumor size [3,5,14,23], proximal tumor location [2,23,29], high tumor grading [2,20], Bormann type IV gastric cancer [2,23], Lauren diffuse pattern [20,29], and signet ring cell histological appearance [23] have been identified as independent risk factors for RM involvement.…”

Report from the 17th Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Edmonton, Alberta; 11–12 September 2015

“…Multiple studies have demonstrated that microscopically positive (R1) margins after resection can be associated with worse prognosis, although the prognostic effect can differ between early-and advanced-stage gc [25][26][27][28][29][30][31] . On multivariate analysis, the predictors for a positive margin include higher T stage, higher N stage, larger tumour size, and diffuse histologic type 24,[28][29][30] .…”