Pathological features and survival analysis of gastric cancer patients with positive surgical margins: A large multicenter cohort study

Tu, Ru Hong; Lin, Jian; Wang, Wei; Li, Ping; Xie, Jian; Wang, Jia Bin; Lü, Jun; Chen, Qi Yue; Cao, Long Long; Ma, Lin; Zheng, Chao; Zhou, Zhiwei; Changming, Huang

doi:10.1016/j.ejso.2019.06.026

Cited by 9 publications

(12 citation statements)

References 23 publications

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“…In case of total gastrectomy for proximal gastric cancer, it is important for surgeons to evaluate the status of proximal resection margin because it could determine the extent of oesophagogastrectomy and surgical method (if thoracotomy needs to be performed). According to the previous reports, the incidence of proximal resection margin involvement was 5.0%–8.2%,9 10 14 which was higher than distal resection margin involvement 4 7. In the present study, 7.6% of patients with proximal gastric cancer had a positive proximal resection margin after postoperative histopathological examination.…”

Section: Discussionsupporting

confidence: 56%

“…The impact of positive resection margins on prognostic outcome in patients with gastric cancer remains controversial. Many studies have demonstrated that resection margin involvement had a negative impact on local recurrence and survival outcomes 3 6–8. Woo et al showed that the median DFS of patients with gastric cancer with positive resection margins was only 11.6 months, which was worse than that of 27.1 months in those with negative resection margins 3.…”

Section: Discussionmentioning

confidence: 99%

“…Woo et al showed that the median DFS of patients with gastric cancer with positive resection margins was only 11.6 months, which was worse than that of 27.1 months in those with negative resection margins 3. The data from two Chinese, high-volume research institutions indicated that the 5-year overall survival (OS) of the patients with positive and negative resection margins were 24.2% and 36.8%, respectively; a significant survival difference between two patient groups was observed 7. However, other studies reported that positive resection margin was not independently associated with recurrence or poor survival outcome in patients with gastric cancer 9 10.…”

Section: Discussionmentioning

confidence: 99%

“…To date, there remains considerable debate regarding the prognostic significance of resection margin status for patients with gastric cancer. Not surprisingly, many studies have demonstrated that microscopical resection margin involvement had a negative impact on local recurrence and survival outcomes 3 6–8. However, other studies reported that positive resection margin was not an independent prognostic factor for patients with gastric cancer, although it was significantly associated with aggressive biological features of tumour 9 10…”

Section: Introductionmentioning

confidence: 99%

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Impact of proximal resection margin involvement on survival outcome in patients with proximal gastric cancer

Zhao

Bao

et al. 2019

J Clin Pathol

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AimThe aim of this study was to evaluate the risk factors for proximal resection margin involvement and its impact on survival outcome in patients with proximal gastric cancer.MethodsA total of 488 patients who underwent potentially curative resection for proximal gastric cancer were retrospectively reviewed. Clinicopathological characteristics and survival differences between patients with positive and negative resection margins were compared and prognostic factors were determined by Cox multivariate analysis.ResultsIn this study, 7.6% (37/488) of patients with proximal gastric cancer had a positive proximal resection margin after postoperative histopathological examination. Positive resection margins were significantly associated with advanced tumour stage and more aggressive biological features including larger tumour size, serosal invasion and lymphovascular invasion. Serosal invasion (OR 4.543, 95% CI 2.201 to 9.380, p<0.001) and lymphovascular invasion (OR 2.279, 95% CI 1.129 to 4.600, p<0.05) were independent risk factors for positive proximal resection margins. In terms of survival outcome, positive resection margins had an adverse impact on the prognosis of patients with proximal gastric cancer (median DFS: 20.7 vs 30.2 months, p<0.001). The multivariate analysis indicated that positive resection margins (HR 1.494, 95% CI 1.042 to 2.142, p=0.029), T stage (T3–T4, HR 2.264, 95% CI 1.484 to 3.454, p<0.001) and N stage (N1–N2 stage, HR 1.696, 95% CI 1.279 to 2.248, p<0.001; N3 stage, HR 2.691, 95% CI 1.967 to 3.681, p<0.001) were independent prognostic factors for patients with proximal gastric cancer.ConclusionProximal resection margin involvement was an indicator of more aggressive tumours and an independent prognostic factor for patients with proximal gastric cancer. Aggressive efforts should be made to achieve a negative resection margin if gastric cancer was deemed to be potentially resectable.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of proximal resection margin involvement on survival outcome in patients with proximal gastric cancer

Zhao

Bao

et al. 2019

J Clin Pathol

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“…Following guidelines on margin length, R0 resection could be achieved in the majority of gastric cancer patients. However, positive resection margin is reported in about 2.8%-8.2% gastric cancer patients who underwent gastrectomy and is associated with poor clinical outcomes ( 5 , 6 ). Intraoperative fluorescence or endoscopic guidance have been used to assist the gastrectomy procedures ( 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

Near-infrared-dye labeled tumor vascular-targeted dimer GEBP11 peptide for image-guided surgery in gastric cancer

et al. 2022

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IntroductionPositive resection margins occur in about 2.8%-8.2% gastric cancer surgeries and is associated with poor prognosis. Intraoperative guidance using Nearinfrared (NIR) fluorescence imaging is a promising technique for tumor detection and margin assessment. The goal of this study was to develop a tumor-specific probe for real-time intraoperative NIR fluorescence imaging guidance.MethodsThe tumor vascular homing peptide specific for gastric cancer, GEBP11, was conjugated with a near-infrared fluorophore, Cy5.5. The binding specificity of the GEBP11 probes to tumor vascular endothelial cells were confirmed by immunofluorescent staining. The ability of the probe to detect tumor lesions was evaluated in two xenograft models. An orthotopic gastric cancer xenograft model was used to evaluate the efficacy of the GEBP11 NIR probes in real-time surgical guidance.ResultsIn vitro assay suggested that both mono and dimeric GEBP11 NIR probes could bind specifically to tumor vascular epithelial cells, with dimeric peptides showed better affinity. In tumor xenograft mice, live imaging suggested that comparing with free Cy5.5 probe, significantly stronger NIR signals could be detected at the tumor site at 24-48h after injection of mono or dimeric GEBP11 probes. Dimeric GEBP11 probe showed prolonged and stronger NIR signals than mono GEBP11 probe. Biodistribution assay suggested that GEBP11 NIR probes were enriched in gastric cancer xenografts. Using dimeric GEBP11 NIR probes in real-time surgery, the tumor margins and peritoneal metastases could be clearly visualized. Histological examination confirmed the complete resection of the tumor.Conclusion(GEBP11)2-ACP-Cy5.5 could be a potential useful probe for intraoperative florescence guidance in gastric cancer surgery.

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Adequate gross resection margin length ensuring pathologically complete resection in gastrectomy for gastric cancer: A systematic review and meta‐analysis

Hayami,

Ohashi,

Kurihara

et al. 2023

Annals of Gastroent Surgery

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AimA positive resection margin (RM) is associated with poor survival after gastrectomy for gastric cancer (GC). However, the adequate RM length to avoid a positive RM remains controversial. We performed a systematic review to examine the RM length required to avoid a positive RM in gastrectomy for GC.MethodsThis systematic review involved all relevant articles identified in PubMed, the Cochrane Library, Web of Science, and ClinicalTrials.gov until August 2023. The incidence of a positive RM related to the RM length and the possible incidence of a positive RM estimated from the discrepancy between the gross and pathological RM length were evaluated. The Newcastle–Ottawa Scale was used to quantify study quality.ResultsThirteen studies involving 8983 patients were analyzed. Investigation of the incidence of a positive RM in relation to the RM length showed that a proximal RM length of 6 cm guaranteed a negative RM in gastrectomy. Analyses of the possible incidence of a positive RM revealed that a negative RM would be guaranteed if the proximal RM length was 6 cm in distal gastrectomy, if the esophageal resection length was 2 cm in total gastrectomy for GC without esophageal invasion and 2.5 cm in total or proximal gastrectomy for GC with esophageal invasion or esophagogastric junction cancer, and if the distal RM length was 4 cm in proximal gastrectomy for early GC.ConclusionsThe adequate RM lengths to ensure a pathologically negative RM in each type of gastrectomy for GC were herein suggested.

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Pathological features and survival analysis of gastric cancer patients with positive surgical margins: A large multicenter cohort study

Cited by 9 publications

References 23 publications

Impact of proximal resection margin involvement on survival outcome in patients with proximal gastric cancer

Impact of proximal resection margin involvement on survival outcome in patients with proximal gastric cancer

Near-infrared-dye labeled tumor vascular-targeted dimer GEBP11 peptide for image-guided surgery in gastric cancer

Adequate gross resection margin length ensuring pathologically complete resection in gastrectomy for gastric cancer: A systematic review and meta‐analysis

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