Clinical impact of tumor infiltration at the transected surgical margin during gastric cancer surgery

Ahn, Sang Hoon; Park, Do Joong; Kim, Hyung‐Ho; Lee, Hyuk Joon; Yang, Han Kwang

doi:10.1002/jso.23123

Cited by 27 publications

(20 citation statements)

References 16 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, IFS analysis is extremely time-consuming and resource-consuming (the estimated cost for a patient is about $1000 for both RMs) [13], and its routine use in all gastric resections, as suggested by some authors [14,15,23], does not seem reliable.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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Background Resection margin (RM) involvement is associated with negative prognosis after gastrectomy. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is timeconsuming and resource-consuming. The aim of this study was to assess risk factors associated with RM involvement to identify patients who would benefit from IFS analysis. Methods We retrospectively analyzed patients who underwent gastrectomy with curative intent for gastric or esophagogastric junction (EGJ) cancer from 2000 to 2014 in six Italian hospitals. RM status was assessed by IFS analysis and/or definitive histopathology examination. A set of 21 potential risk factors were compared in a multivariate analysis between patients with positive RMs on IFS analysis or definitive histopathology examination and a control cohort of similar patients with negative RMs, with the samples stratified into three subgroups (T1, T2-T4 Lauren intestinal pattern, T2-T4 Lauren diffuse/mixed pattern). Results One hundred forty-five patients had positive RMs. Survival was significantly worse in positive RM patients than in negative RM patients (89.5 months vs 28.9 months). Multivariate analysis showed that in T1 cancers a margin distance of less than 2 cm is a risk factor for RM involvement (odds ratio 15.7), in T2-T4 intestinal pattern cancers, serosa invasion (odds ratio 6.0), EGJ location (odds ratio 4.1), and a margin distance of less than 3 cm (odds ratio 4.0) are independent risk factors, and in T2-T4 diffuse/mixed pattern cancers, lymphatic infiltration (odds ratio 4.2), tumor diameter greater than 4 cm (odds ratio 3.5), EGJ location (odds ratio 2.8), and serosa invasion (odds ratio 2.2) are independent risk factors. Conclusions Survival after gastrectomy is negatively affected by positive RMs. IFS analysis should be routinely used in patients with a high risk of positive RMs, especially in diffuse pattern cancers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…In Abhängigkeit von der Lokalisation der vorausgegangenen R1-Resektion und der funktionellen Operabilität sollte der Versuch einer Nachoperation mit dem Ziel der R0-Resektion unternommen werden. [474][475][476]. Zwei Studien der US Gastric Cancer Collaborative befassten sich mit den proximalen Sicherheitsabständen bei der Magenresektion.…”

Section: Hintergrundunclassified

S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs – Langversion 2.0 – August 2019. AWMF-Registernummer: 032/009OL

Moehler¹,

Al-Batran²,

Andus³

et al. 2019

Z Gastroenterol

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“…Frozen section margin positivity has been independently associated with tumor location in the proximal stomach, presence of signet ring cells, larger tumors (>5 cm), and more infiltrative disease [36,37]. For proximal tumors of the cardia, positive frozen section margins have been associated with increased T stage [34].…”

Section: The Value Of Intraoperative Frozen Section Analysis Of Marginsmentioning

confidence: 99%

The importance of surgical margins in gastric cancer

Postlewait

Maithel

2015

Journal of Surgical Oncology

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Interpretation and management of the surgical margin is paramount to the treatment of gastric adenocarcinoma. Although in early-stage disease, a microscopically positive margin may be associated with poor outcomes, in later stages, it does not persist as an independent poor prognostic factor but rather is likely a marker of other adverse pathologic characteristics that ultimately determine outcomes. Thus, the decision to extend a resection to achieve a negative margin should be deliberate and individualized.

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Clinical impact of tumor infiltration at the transected surgical margin during gastric cancer surgery

Abstract: Microscopic tumor involvement at the margin during gastric cancer surgery does not increase locoregional and/or peritoneal recurrence or overall recurrence independently if R0 resection is achieved by re-resection of the margin.

Cited by 27 publications

References 16 publications

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

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

S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs – Langversion 2.0 – August 2019. AWMF-Registernummer: 032/009OL

The importance of surgical margins in gastric cancer

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