Prognostic impact of microscopic positive margin in gastric cancer patients

Nagata, Tomoyuki; Ichikawa, Daisuke; Komatsu, Shuhei; Inoue, Koji; Shiozaki, Atsushi; Fujiwara, Hitoshi; Okamoto, Kazuma; Sakakura, Chohei; Otsuji, Eigo

doi:10.1002/jso.22022

Cited by 57 publications

(51 citation statements)

References 18 publications

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“…The prognostic impact of this RM involvement by the tumor has been widely studied by several authors: in a multicenter Italian study, Morgagni et al [4] showed that RM infiltration is an independent unfavorable factor in patients who underwent gastrectomy (OR 1.5), with a 5-year OS rate of 66 % in R0 resections and 29 % in R1 resections. Eastern authors [3,5,14,15] observed similar results, with an unstratified 5-year survival rate ranging from 53 to 60 % in the case of R0 resections, and from 13 to 26 % in case of R1 resections. In the present study we found that the 5-year survival rate of the whole cohort was 59 % in patients with negative RMs and 22 % in patients with positive RMs; therefore, the data we are presenting perfectly overlap with those reported in the literature.…”

Section: Discussionmentioning

confidence: 62%

“…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%

“…Whereas the prognostic impact or RM involvement by the tumor is still to be defined, especially in specific cases such as early gastric cancer (EGC) or low-stage gastric cancer [1][2][3], it is commonly accepted that positive margins are an independent unfavorable factor associated with worse survival after surgical resection [4,5]. Therefore, in the field of & Massimiliano Bissolati maxbisso@gmail.com gastric cancer surgical oncology, every effort must be made to obtain a complete resection with negative margins and adequate lymph node dissection, which constitutes the only possible curative treatment for nonmetastatic gastric cancer, and reoperation should always be considered in the case of R1 resections [4].…”

Section: Introductionmentioning

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: 62%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…The prevalence of positive resection margins after gastric surgery for gastric cancer varies from 2.8 to 19% in gastric cancer and there are many reports on related factors and prognosis 10–12. However, whether reoperation should be performed to achieve complete resection or not is controversial.…”

Section: Discussionmentioning

confidence: 99%

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

Ahn

Park

Kim

et al. 2012

Journal of Surgical Oncology

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“…However, many reports regarding the clinical importance of a positive margin did not describe the method of evaluation of the true surgical margin or the most appropriate device to dissect the tissue. Although a positive margin has often been associated with poor prognosis in gastric cancer [5][6][7][8], it has lost prognostic relevance in some specific cohorts [9][10][11]. Besides the biological characteristics of these specific cohorts, inaccurate handling of the surgical margin for histologic evaluation may have led to these conflicting results.…”

Section: Discussionmentioning

confidence: 99%

In vivo evaluation of a modified linear stapling device designed to facilitate accurate pathologic examination of the surgical margin

et al. 2015

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Background Microscopic involvement of the resection margin could influence the long-term outcome of patients undergoing curative surgery for gastric cancer. Linear staplers, commonly used for gastrectomies, are often equipped with three lines of staples on either side of the resection line. Although multiple lines of staples reinforce closure of the gastric or intestinal stump, they could hinder accurate histopathologic evaluation of the surgical margin of the resected specimen. Methods We modified a linear stapling device by removing one line (stapler E2) or two lines (stapler E1) of staples on the specimen side, and attempted to dissect a silicon film and then the stomach from a porcine model using the stapling device and examined the distances between the cutting edge and the nearest staple line. Results The distance between the cutting edge and the staple line for stapler E1 was significantly greater than the distance between the cutting edge and the nearest staple line for stapler E2 or the control device. Consequently, specimens of exemplary quality were available for pathologic examination of the surgical margin. Moreover, the lack of multiple layers of staples did not result in contamination of the abdominal cavity with gastric juice during laparoscopic procedures in the porcine model. Conclusions Stapler E1 is safe and could be useful for the pathologic evaluation of the true surgical margin.

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Prognostic impact of microscopic positive margin in gastric cancer patients

Abstract: Microscopic positive margin was found to be an independent prognostic factor in gastric cancer patients. The status of the surgical margin might provide useful information for selecting additional treatments and performing intensive follow-up.

Cited by 57 publications

References 18 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

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

In vivo evaluation of a modified linear stapling device designed to facilitate accurate pathologic examination of the surgical margin

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