Kosin Med J.  2012 Jun;27(1):31-36. 10.7180/kmj.2012.27.1.31.

Clinical Outcome of Positive Margin of Postgastrectomy with Adenocarcinoma of Stomach

• Yang SI
• Lee SH

• KMID: 1993584
• DOI: http://doi.org/10.7180/kmj.2012.27.1.31

Abstract

OBJECTIVES
Many investigators have recommended adequate resection margin and lymphadenectomy for radical curative resection. The aim of this study is to evaluate clinical characteristics of positive resection margin (proximal or distal) of postgastrectomy in advanced gastric cancer.
METHODS
We studied 17 patients with gastric cancer who were diagnosed positive resection margin by intraoperative frozen biopsy or permanent biopsy report from January 2005 to December 2007, retrospectively. Surgical margin monitored by endoscopy.
RESULTS
Distal gastrectomy was performed in 13 patients and total gastrectomy in 4. Gastrectomy with combined resection including splenectomy was performed in 3, distal pancreatectomy in 2, transverse colon segmental resection in 1, and cholecystectomy in 2. Positive Proximal margin was found in 12, positive distal margin in 3, and both in 2. Palliative chemotherapy was performed in 8 patients. Postoperative follow up endoscopy was established in only 8 patients. Malignant results from endoscopic biopsy in gastroenteric or esophagoenteric anastomotic line were proven in 2 patients during follow up. 9 patients were not performed follow-up endoscopy. Among total 17 patients, 2 patients are alive. Fifteen patients died of aggravation of disease in 13 and postoperative complication in 2.
CONCLUSIONS
Although positive surgical margin in far advanced gastric cancer were found, it can consider that does not further resection to obtain microscopic clear anastomotic margin.

Keyword

Advanced gastric cancer; Palliative resection; Positive resection margin

MeSH Terms

Adenocarcinoma
Biopsy
Cholecystectomy
Colon, Transverse
Endoscopy
Follow-Up Studies
Gastrectomy
Humans
Lymph Node Excision
Pancreatectomy
Postoperative Complications
Research Personnel
Retrospective Studies
Splenectomy
Stomach
Stomach Neoplasms

Figure

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  Fig. 1 Types of reconstruction after gastric surgery of the stage IV patient

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  Fig. 2 Positive surgical margin of the reconstruction type

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  Fig. 3 Prognosis of margin positive case

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  Fig. 4 Prgnosis of margin positive case followed by endoscopy

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