Resection margin in patients with gastric cancer associated with esophageal invasion: Clinicopathological study

Abstract

We investigated the correlations between resection margin involvement by carcinoma and a number of clinicopathological features in patients with gastric cancer and esophageal invasion. From January 1968 to December 1988, 1,040 patients with carcinoma of the stomach underwent gastric resection. Thirty-nine patients had tumor infiltration of the esophagus on histological examination of the resected specimens. The patients were divided into two groups on microscopic examination: those in whom the resection margin was less than 5 mm wide, and those in whom it exceeded 5 mm microscopically. There were 6 and 33 patients in the narrow and wide margin groups, respectively. There were statistically significant differences in tumor size, depth of cancer invasion, and macroscopic appearance between the two groups. The risk of resection margin involvement was high in tumors with the following features: large Borrmann type 4 tumor (macroscopic appearance and size) and infiltrative carcinoma (depth of invasion).

Prognostic impact of microscopic positive margin in gastric cancer patients

“…The microscopic positive margin was found in 2.8% of gastric cancer patients in the present study (14.5% of all patients including non-curative cases; data not shown), which is consistent with previous studies reporting the rates from 1% to 20% [7][8][9][10][11]. Concerning the prognostic impact of surgical margin status, previous reports demonstrated that a positive margin was associated with a worse outcome [7,12,13].…”

Adenocarcinoma of the Gastroesophageal Junction

“…15 As a result, resection of up to 10 cm of macroscopically normal in situ esophagus above the tumor has been recommended to ensure R0 resection on the assumption that this will improve outcome. 7,12,17,41,42 In keeping with these findings, microscopic tumor infiltration of the esophageal transaction line occurred in patients with shorter proximal margins than patients with negative esophageal margins, although a positive margin was found in one specimen with an 8 cm length of grossly normal esophagus. To determine the association between the length of grossly normal esophageal resection margin and outcome, we analyzed survival only for those patients that underwent R0 resection to avoid any influence of the known negative prognostic association with R1 resection.…”

Prognosis of upper-third gastric carcinoma patients with invasion of the lower esophagus

“…Takeshita et al [9] and Bozzetti et al [10] support this result. According to Okamura et al [11] and Yokota et al [12], Borrmann IV type carcinoma is more common in these patients. Borrmann IV type carcinoma was more frequently found in patients having upper-third gastric carcinoma with esophageal invasion compared to patients without esophageal invasion (28.6% vs 6.3%, P<0.001), and 27 patients (64.3%) were classified as having either stage III or IV disease at initial diagnosis in our study.…”