Clinical Evaluation of Routine Frozen Section Study of Resection Margin in Curative Gastric Surgery

Hahn, Ki Ho; Yang, Han Kwang; Kim, Jin Pok

Abstract

To avoid residual cancer in resection lines, some authors have recommended routine frozen section study of both resection margins during gastric cancer surgery. Therefore, to evaluate the significance of the routine frozen section study of resection margins in radical gastric cancer surgery, the authors analysed frozen resection margins of 2107 consecutive curative gastrectomy cases from Jan. 1988 to Jun. 1994. The following results were obtained. We experienced 117 cases of true positive resection margin by frozen section examination. In 65 cases, proximal resection margin was positive. In 52 cases distal resection margin was positive. True positive frozen resection rate was 5.6%(117/2107) total, 3.1% in proximal resection margin, 2.5% in distal resection margin. In 19 cases, frozen section study was false negative. The false negative rate was 14.0%. In 4 cases, frozen section study was false positive. The false positive rate was 0.2%. The results of diagnostic accuracy of frozen section study was as follows.: accuracy was 98.9%, sensitivity 86.0%, specificity 99.8%, positive predictive value 96.7%, negative predictive value 99.0%. Among the cancer located at antrum and body, the proximal margin was positive in 43 cases (EGC: 10 cases, AGC: 33 cases). The distance from tumor border to the proximal margin was greater than 2 cm in 2 EGC cases and greater than 6 cm in 8 AGC cases. Among the cancer located at cardia, the proximal margin was positive in 22 cases (EGC: 1, AGC: 21). The distance from the esophagogastric junction to the proximal margin was greater than 3 cm in 3 cases. Among the cancer located at pylorus, the distal margin was positive in 23 cases (AGC: 23). The distance from the pyloric ring to the distal margin was greater than 2 cm in 6 cases. Among the cancer located in antrum and body, the distal margin was positive in 29 cases (EGC: 3, AGC: 26). The distance from the tumor border to the distal margin was greater than 6 cm in 1 case. In conclusion, the present study indicates that resection margin can be infiltrated by the cancer cell though the distance to resection margin is greater than the recommended distance and frozen section study offers acceptable diagnostic accuracy, so we recommend the routine frozen section study of resection margins during gastric cancer surgery.