Prognostic Significance of Microscopic Positive Margins for Gastric Cancer Patients with Potentially Curative Resection

Abstract

A positive margin results in a significantly worse outcome for pT1-2, pN0-1, and I-II stage gastric cancer patients who undergo D2/D3 lymphadenectomy, but not for those in pT3-4, pN2-3, and III-IV stage.

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

“…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.…”

“…However, although the effect of R1 resection is undoubtedly negative on the whole series population, the definitive prognostic significance in a specific subgroup of patients is still to be defined. Sun et al [3] found that R1 resections affect prognosis only in T1-T2 cancer patients, whereas Cho et al [2] identified a worse survival only in N0-N1 cancer patients. These authors suggest that R1 resections may have a negative impact only in low-stage cancer patients, because the adverse effects of positive RMs might be overwhelmed by the more detrimental impact of the depth of invasion or nodal metastasis.…”

“…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].…”

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] . Use of ifs of the resection lines is common for the assessment of margin status.…”

Emphasis on Preventing Microscopic Positive Margins in Gastric Cancer

“…1 They compared clinicopathologic and survival follow-up data between 110 patients with positive margins and 2,159 patients with negative margins. All patients had undergone gastrectomy with D2/D3 lymphadenectomy.…”