Ann Surg Treat Res.  2014 Nov;87(5):223-231. 10.4174/astr.2014.87.5.223.

The distance of proximal resection margin dose not significantly influence on the prognosis of gastric cancer patients after curative resection

• Kim MG
• Lee JH
• Ha TK
• Kwon SJ

• KMID: 2266880
• DOI: http://doi.org/10.4174/astr.2014.87.5.223

Abstract

PURPOSE
It is well known that the curative resection with an adequate proximal margin length is the most effective treatment in gastric cancer. However, despite surgeon's effort to achieve a sufficient proximal margin length, it is often difficult to obtain a recommended proximal margin length in some cases. Therefore, this study was planned to investigate the impact of the length of proximal margin on prognosis of overall survival.
METHODS
Between June 1992 and December 2010, 1,888 gastric cancer patients who underwent gastrectomy with curative intent were reviewed. According to tumor's location (total vs. subtotal gastrectomy), pathologic T staging, and differentiation, univariate and multivariate analyses were performed to evaluate the impact of the discrepancies of proximal margin length on overall survival. Also, the impact of the discrepancies of proximal margin length on local recurrence was assessed.
RESULTS
The 5-year survival rate of positive proximal margin group was 5.9%. In negative proximal margin groups, multivariate analysis showed that the discrepancies of proximal margin length have no impact on overall survival. Kaplan-Meier analyses showed that there is no association between discrepancy of proximal margin length and local recurrence.
CONCLUSION
It takes effort to secure a negative proximal margin in the surgical treatment of gastric cancer because of the poor prognosis of positive proximal margin. In negative proximal margin patients, there's no need to achieve an additional proximal margin length for long-term survival benefit because there was no impact of proximal margin length on overall survival and local recurrence.

Keyword

Gastric cancer; Proximal margin length; Overall survival; Local recurrence

MeSH Terms

Gastrectomy
Humans
Multivariate Analysis
Prognosis*
Recurrence
Stomach Neoplasms*
Survival Rate

Reference

1. Cunningham SC, Kamangar F, Kim MP, Hammoud S, Haque R, Maitra A, et al. Survival after gastric adenocarcinoma re section: eighteen-year experience at a single institution. J Gastrointest Surg. 2005; 9:718–725.

2. Roukos DH. Current status and future perspectives in gastric cancer management. Cancer Treat Rev. 2000; 26:243–255.

3. Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006; 12:354–362.

4. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011; 61:69–90.

5. Goggins WB, Wong GK. Poor survival for US Pacific Islander cancer patients: evidence from the Surveillance, Epidemiology, and End Results database: 1991 to 2004. J Clin Oncol. 2007; 25:5738–5741.

6. Maehara Y, Kakeji Y, Oda S, Takahashi I, Akazawa K, Sugimachi K. Time trends of surgical treatment and the prognosis for Japanese patients with gastric cancer. Br J Cancer. 2000; 83:986–991.

7. Sun Z, Li DM, Wang ZN, Huang BJ, Xu Y, Li K, et al. Prognostic significance of microscopic positive margins for gastric can cer patients with potentially curative re section. Ann Surg Oncol. 2009; 16:3028–3037.

8. Munson JL, O'Mahony R. Radical gastrectomy for cancer of the stomach. Surg Clin North Am. 2005; 85:1021–1032.

9. McCulloch P. The role of surgery in patients with advanced gastric cancer. Best Pract Res Clin Gastroenterol. 2006; 20:767–787.

10. Kasakura Y, Fujii M, Mochizuki F, Imai S, Kanamori N, Suzuki T. Clinicopathological features of the superficial spreading type of early gastric cancer. Gastric Cancer. 1999; 2:129–135.

11. Schrock TR, Way LW. Total gastrectomy. Am J Surg. 1978; 135:348–355.

12. Papachristou DN, Agnanti N, D'Agostino H, Fortner JG. Histologically positive esophageal margin in the surgical treatment of gastric cancer. Am J Surg. 1980; 139:711–713.

13. Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma - 2nd English Edition -. Gastric Cancer. 1998; 1:10–24.

14. Esaki Y, Hirayama R, Hirokawa K. A comparison of patterns of metastasis in gastric cancer by histologic type and age. Cancer. 1990; 65:2086–2090.

15. Ishigami S, Natsugoe S, Miyazono F, Hata Y, Uenosono Y, Sumikura S, et al. Clinical merit of subdividing gastric cancer according to invasion of the muscularis propria. Hepatogastroenterology. 2004; 51:869–871.

16. Borch K, Jonsson B, Tarpila E, Franzen T, Berglund J, Kullman E, et al. Changing pattern of histological type, location, stage and outcome of surgical treatment of gastric carcinoma. Br J Surg. 2000; 87:618–626.

17. Msika S, Benhamiche AM, Jouve JL, Rat P, Faivre J. Prognostic factors after curative resection for gastric cancer. A population-based study. Eur J Cancer. 2000; 36:390–396.

18. Maehara Y, Kakeji Y, Koga T, Emi Y, Baba H, Akazawa K, et al. Therapeutic value of lymph node dissection and the clinical outcome for patients with gastric cancer. Surgery. 2002; 131:1 Suppl. S85–S91.

19. Yokota T, Kunii Y, Teshima S, Yamada Y, Saito T, Takahashi M, et al. Significant prognostic factors in patients with early gastric cancer. Int Surg. 2000; 85:286–290.

20. Adachi Y, Shiraishi N, Suematsu T, Shiromizu A, Yamaguchi K, Kitano S. Most important lymph node information in gastric cancer: multivariate prognostic study. Ann Surg Oncol. 2000; 7:503–507.

21. Pinto-De-Sousa J, David L, Seixas M, Pimenta A. Clinicopathologic profiles and prognosis of gastric carcinomas from the cardia, fundus/body and antrum. Dig Surg. 2001; 18:102–110.

22. 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:433–437.

23. 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.

24. Hallissey MT, Jewkes AJ, Dunn JA, Ward L, Fielding JW. Resection-line involvement in gastric cancer: a continuing problem. Br J Surg. 1993; 80:1418–1420.

25. Yokota T, Sawai K, Yamaguchi T, Taniguchi H, Shimada S, Yoneyama C, et al. Resection margin in patients with gastric cancer associated with esophageal invasion: clinicopathological study. J Surg Oncol. 1993; 53:60–63.

26. Jang YJ, Park MS, Kim JH, Park SS, Park SH, Kim SJ, et al. Advanced gastric cancer in the middle one-third of the stomach: Should surgeons perform total gastrectomy. J Surg Oncol. 2010; 101:451–456.

27. Stein HJ, Sendler A, Siewert JR. Site-dependent resection techniques for gastric cancer. Surg Oncol Clin N Am. 2002; 11:405–414.

28. Hermann RE. Newer concepts in the treatment of cancer of the stomach. Surgery. 1993; 113:361–364.

29. Kim JP, Kwon OJ, Oh ST, Yang HK. Results of surgery on 6589 gastric cancer patients and immunochemosurgery as the best treatment of advanced gastric cancer. Ann Surg. 1992; 216:269–278.

30. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14:113–123.