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. 2020 May 14;26(18):2232-2246.
doi: 10.3748/wjg.v26.i18.2232.

Optimal proximal resection margin distance for gastrectomy in advanced gastric cancer

Amy Kim  1 , Beom Su Kim  2 , Jeong Hwan Yook  1 , Byung Sik Kim  1
Affiliations

Optimal proximal resection margin distance for gastrectomy in advanced gastric cancer

Amy Kim et al. World J Gastroenterol. .

Abstract

Background: The conventional guidelines to obtain a safe proximal resection margin (PRM) of 5-6 cm during advanced gastric cancer (AGC) surgery are still applied by many surgeons across the world. Several recent studies have raised questions regarding the need for such extensive resection, but without reaching consensus. This study was designed to prove that the PRM distance does not affect the prognosis of patients who undergo gastrectomy for AGC.

Aim: To investigate the influence of the PRM distance on the prognosis of patients who underwent gastrectomy for AGC.

Methods: Electronic medical records of 1518 patients who underwent curative gastrectomy for AGC between June 2004 and December 2007 at Asan Medical Center, a tertiary care center in Korea, were reviewed retrospectively for the study. The demographics and clinicopathologic outcomes were compared between patients who underwent surgery with different PRM distances using one-way ANOVA and Fisher's exact test for continuous and categorical variables, respectively. The influence of PRM on recurrence-free survival and overall survival were analyzed using Kaplan-Meier survival analysis and Cox proportional hazard analysis.

Results: The median PRM distance was 4.8 cm and 3.5 cm in the distal gastrectomy (DG) and total gastrectomy (TG) groups, respectively. Patient cohorts in the DG and TG groups were subdivided into different groups according to the PRM distance; ≤ 1.0 cm, 1.1-3.0 cm, 3.1-5.0 cm and > 5.0 cm. The DG and TG groups showed no statistical difference in recurrence rate (23.5% vs 30.6% vs 24.0% vs 24.7%, P = 0.765) or local recurrence rate (5.9% vs 6.5% vs 8.4% vs 6.2%, P = 0.727) according to the distance of PRM. In both groups, Kalpan-Meier analysis showed no statistical difference in recurrence-free survival (P = 0.467 in DG group; P = 0.155 in TG group) or overall survival (P = 0.503 in DG group; P = 0.155 in TG group) according to the PRM distance. Multivariate analysis using Cox proportional hazard model revealed that in both groups, there was no significant difference in recurrence-free survival according to the PRM distance.

Conclusion: The distance of PRM is not a prognostic factor for patients who undergo curative gastrectomy for AGC.

Keywords: Gastrectomy; Margins of excision; Prognosis; Recurrence; Stomach neoplasms.

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Conflict of interest statement

Conflict-of-interest statement: None of the authors have any conflict of interest or financial ties to disclose.

Figures

Figure 1
Figure 1
Correlation of overall survival (A) and recurrence-free survival (B) with the distance of proximal resection margin in patients who underwent distal gastrectomy. Kaplan-Meier method was used to analyze OS and RFS according to the distance of PRM. There were no significant differences between the PRM subgroups. OS: Overall survival; RFS: Recurrence-free survival; PRM: Proximal resection margin.
Figure 2
Figure 2
Correlation of overall survival (A) and recurrence-free survival (B) with the distance of proximal resection margin in patients who underwent total gastrectomy. The Kaplan-Meier method was used to analyze OS and RFS according to the distance of PRM. There were no significant differences between the PRM subgroups. OS: Overall survival; RFS: Recurrence-free survival; PRM: Proximal resection margin.
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