The importance of surgical margins in gastric cancer

Postlewait, Lauren M.; Maithel, Shishir K.

doi:10.1002/jso.24110

Cited by 31 publications

(15 citation statements)

References 59 publications

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“…The correlation between microscopically positive RM and outcomes in patients with gastric cancer remains an issue of debate [2,3]. However, several previous studies have reported that microscopically positive RM had an unfavorable impact on survival [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Risk factors analysis and stratification for microscopically positive resection margin in gastric cancer patients

Kumazu

Hayashi

Yoshikawa³

et al. 2020

BMC Surg

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Background: Cancer cells are often found postoperatively at surgical resection margins (RM) in patients with gastric cancer because of submucosal infiltration or hesitation to secure adequate RM. This study was designed to evaluate risk factors for microscopic positive RM and to clarify which patients should undergo intraoperative frozen section diagnosis (IFSD). Methods: Patients who underwent R0/1 gastrectomy for gastric adenocarcinoma between 2000 and 2018 in a single cancer center in Japan were studied. We divided the patients into a positive RM group and negative RM group according to the results of definitive histopathological examinations. We performed multivariate analysis to analyze risk factors for positive RM by and used the identified risk factors to risk stratify the patients. Results: A total of 2757 patients were studied, including 49 (1.8%) in the positive RM group. The risk factors significantly associated with positive RM were remnant gastric cancer (odds ratio [OR] 4.7), esophageal invasion (OR 6.3), tumor size ≥80 mm (OR 3.9), and a histopathological diagnosis of undifferentiated type (OR 3.6), macroscopic type 4 (OR 3.7), or pT4 disease (OR 4.6). On risk stratification analysis, the incidence of positive RM was 0.1% without any risk factors, increasing to 0.4% with one risk factor, 3.1% with two risk factors, 5.3% with three risk factors, 21.3% with four risk factors, and 85.7% with five risk factors. Conclusions: The risk of macroscopically positive RM increased in patients who have risk factors. IFSD should be performed in patients who have four or more risk factors.

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Section: Introductionmentioning

confidence: 99%

Risk factors analysis and stratification for microscopically positive resection margin in gastric cancer patients

Kumazu

Hayashi

Yoshikawa³

et al. 2020

BMC Surg

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“…Oncologic outcome is a criterion of success in cancer surgery. Both the distance from the proximal resection margin and the number of harvested LNs correspond with the oncologic outcome during the short postoperative period of gastric cancer surgery [5,14]. In this study, these two variables were not different significantly between the TP-LDG and FP-LDG groups.…”

Section: Discussionmentioning

confidence: 59%

Three-Port Versus Five-Port Laparoscopic Distal Gastrectomy for Early Gastric Cancer Patients: A Propensity Score Matched Case-Control Study

2017

Journal of Investigative Surgery

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“…We deemed surgeons’ experience played an important role as the majority of surgeons converted to DA after they had matured LADG BI [ 13 , 19 ]. Both DA and LADG BI achieved proximal resection margins more than 3cm that was believed to improve oncological outcomes[ 35 ]. Pooled analysis also demonstrated these two approaches achieved similar proximal surgical margins and overall survival rate.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Delta-Shape Anastomosis and Extracorporeal Billroth I Anastomosis after Laparoscopic Distal Gastrectomy for Gastric Cancer: A Systematic Review with Meta-Analysis of Short-Term Outcomes

Feng

et al. 2016

PLoS ONE

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ObjectiveThe aim of this systematic review and meta-analysis is to evaluate the safety and relative benefits of delta-shape anastomosis (DA) by comparing to conventional laparoscopy-assisted distal gastrectomy with Billroth I gastroduodenostomy (LADG BI).MethodsStudies and relevant literature regarding DA versus LADG BI were searched in the electronic databases. Operation time, postoperative complications, estimated blood loss, number of retrieved lymph nodes, time to first flatus, time to oral intake, length of postoperative hospitalization in DA and LADG BI were pooled and compared using meta-analysis. Weighted mean differences (WMDs) and odds ratios (ORs) were calculated with 95% confidence intervals (CIs) to evaluate the effect of DA.ResultsEight studies of 1739 patients were included in the meta-analysis. Compared with LADG BI, DA had shorter postoperative hospitalization (WMD = -0.47, 95%CI: -0.69 to -0.25, P<0.01), less blood loss (WMD = - 25.90, 95%CI: -43.11 to -8.70, P<0.01), shorter time to oral intake (WMD = -0.25, 95%CI: -0.49 to -0.01, P = 0.04), and more retrieved lymph nodes (WMD = 1.36, 95%CI: 0.30 to 2.43, P = 0.01). Operation time (WMD = -0.07, 95%CI -15.58 to 15.43, P = 0.99), overall postoperative complication rate (OR = 1.05, 95%CI: 0.74 to 1.49, P = 0.63), surgical complication rate (OR = 1.02, 95%CI: 0.70 to 1.49, P = 0.90), nonsurgical complication rate (OR = 1.21, 95%CI: 0.54 to 2.72, P = 0.64), leakage rate (OR = 2.54, 95%CI: 0.92 to 7.01, P = 0.07), stricture rate (OR = 0.36, 95%CI: 0.09 to 1.44, P = 0.15), wound complication rate (OR = 0.71, 95%CI: 0.33 to 1.55, P = 0.39), time to first flatus (WMD = -0.10, 95%CI: -0.27 to 0.07, P = 0.26), and proximal surgical margin (WMD = -0.25, 95%CI: -1.14 to 0.65, P = 0.59) was not statistically different.ConclusionCompared with LADG BI, DA is a safe and feasible procedure, with significantly reduced blood loss, time to oral intake, and postoperative hospitalization.

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The importance of surgical margins in gastric cancer

Cited by 31 publications

References 59 publications

Risk factors analysis and stratification for microscopically positive resection margin in gastric cancer patients

Risk factors analysis and stratification for microscopically positive resection margin in gastric cancer patients

Three-Port Versus Five-Port Laparoscopic Distal Gastrectomy for Early Gastric Cancer Patients: A Propensity Score Matched Case-Control Study

Comparison of Delta-Shape Anastomosis and Extracorporeal Billroth I Anastomosis after Laparoscopic Distal Gastrectomy for Gastric Cancer: A Systematic Review with Meta-Analysis of Short-Term Outcomes

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