Abstract
Purpose
To examine the association between positive resection margins and survival and local recurrence in patients with gastric cancer undergoing resection with curative intent.
Methods
Patients who underwent curative intent resection for gastric carcinoma from 1985 to 2010 were identified from a prospectively maintained database. Positive margins were defined as disease present at the line of luminal transection. Clinicopathological features and outcome of patients undergoing gastrectomy with negative and positive margins were compared.
Results
Among 2384 patients undergoing curative intent resection, 108 (4.5 %) had positive margins. Positive margins were associated with higher American Joint Committee on Cancer (AJCC) stage, T stage, N stage, median number of positive nodes, diffuse Lauren type, and poorly differentiated tumors. Treatment of positive margins consisted of: observation (39 %), chemoradiotherapy (26 %), chemotherapy (20 %), repeat resection (10 %), radiotherapy (4 %), and unknown (1 %). Multivariate analysis of the entire cohort demonstrated margin status, T stage, N stage, grade, and perineural invasion to be independent predictors of survival. Margin status was an independent predictor of survival in patients with ≤3 positive nodes or T1–2 disease but was not in patients with >3 positive nodes or T3–4 disease. Local recurrence occurred in 16 % of patients with a positive margin. We identified no factors predictive of local recurrence in patients with positive margins.
Conclusions
Positive resection margin is associated with advanced AJCC stage and aggressive tumor biology but remains an independent predictor of worse survival. The significance of a positive margin in gastric cancer is confined to patients with nontransmural disease and/or limited nodal involvement.
Similar content being viewed by others
References
Papachristou DN, Fortner JG. Local recurrence of gastric adenocarcinomas after gastrectomy. J Surg Oncol. 1981;18:47–53.
Kim SH, Karpeh MS, Klimstra DS, Leung D, Brennan MF. Effect of microscopic resection line disease on gastric cancer survival. J Gastrointest Surg. 1999;3:24–33.
British Stomach Cancer Group. Resection line disease in stomach cancer. Br Med J (Clin Res Ed). 1984;289(6445):601–3.
Shiu MH, Moore E, Sanders M, et al. Influence of the extent of resection on survival after curative treatment of gastric carcinoma. A retrospective multivariate analysis. Arch Surg. 1987;122:1347–51.
Shiu MH, Perrotti M, Brennan MF. Adenocarcinoma of the stomach: a multivariate analysis of clinical, pathologic and treatment factors. HePatogastroenterology. 1989;36:7–12.
Gall CA, Rieger NA, Wattchow DA. Positive proximal resection margins after resection for carcinoma of the oesophagus and stomach: effect on survival and symptom recurrence. Aust N Z J Surg. 1996;66:734–7.
Wang SY, Yeh CN, Lee HL, et al. Clinical impact of positive surgical margin status on gastric cancer patients undergoing gastrectomy. Ann Surg Oncol. 2009;16:2738–43.
McNeer G, Sunderland DA, McInnes G, Vandenberg HJ Jr, Lawrence W Jr. A more thorough operation for gastric cancer; anatomical basis and description of technique. Cancer. 1951;4:957–67.
Wangensteen OH, et al. The second look operation in the management of abdominal cancer. In: Hoebner PB, editor. Treatment of cancer and allied diseases. New York; 1962. p. 62.
Iwanaga T, Koyama H, Furukawa H, Taniguchi H, Wada A, Tateishi R. Mechanisms of late recurrence after radical surgery for gastric carcinoma. Am J Surg. 1978;135:637–40.
D’Angelica M, Gonen M, Brennan MF, Turnbull AD, Bains M, Karpeh MS. Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg. 2004;240:808–16.
Papachristou DN, Agnanti N, D’Agostino H, Fortner JG. Histologically positive esophageal margin in the surgical treatment of gastric cancer. Am J Surg. 1980;139:711–3.
AJCC. American Joint Committee on Cancer staging manual. 7th edition. Chicago, IL: Springer; 2010.
Songun I, Bonenkamp JJ, Hermans J, van Krieken JH, van de Velde CJ. Prognostic value of resection-line involvement in patients undergoing curative resections for gastric cancer. Eur J Cancer. 1996;32A:433–7.
Cho BC, Jeung HC, Choi HJ, et al. Prognostic impact of resection margin involvement after extended (D2/D3) gastrectomy for advanced gastric cancer: a 15-year experience at a single institute. J Surg Oncol. 2007;95:461–8.
Acknowledgment
The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bickenbach, K.A., Gonen, M., Strong, V. et al. Association of Positive Transection Margins with Gastric Cancer Survival and Local Recurrence. Ann Surg Oncol 20, 2663–2668 (2013). https://doi.org/10.1245/s10434-013-2950-5
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-013-2950-5