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. 2023 Nov 7;23(1):1075.
doi: 10.1186/s12885-023-11570-2.

A shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer

Yusuke Takashima #  1 , Shuhei Komatsu #  2 , Keiji Nishibeppu  1 , Takuma Ohashi  1 , Toshiyuki Kosuga  1 , Hirotaka Konishi  1 , Atsushi Shiozaki  1 , Takeshi Kubota  1 , Hitoshi Fujiwara  1 , Eigo Otsuji  1
Affiliations

A shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer

Yusuke Takashima et al. BMC Cancer. .

Abstract

Background: Although a 3-5 cm surgical margin distance is recommended for advanced gastric cancer (GC) in Japanese guidelines, little is known about the clinical effects of the surgical margin, especially the distal resection margin (DM). This study aims to clarify the clinical significance of DM in GC.

Methods: A total of 415 GC patients who underwent curative distal gastrectomy between 2008 and 2018 were analyzed retrospectively.

Results: The DM significantly stratified recurrence-free survival (P = 0.002), and a DM < 30 mm was an independent factor of a poor prognosis (P = 0.023, hazard ratio: 1.91). Lymphatic recurrence occurred significantly more frequently in the DM < 30 mm group than in the DM ≥ 30 mm group (P = 0.019, 6.9% vs. 1.9%). Regarding the station No.6 lymph node metastases in advanced GC (DM < 30 mm vs. 30 mm ≤ DM ≤ 50 mm vs. DM > 50 mm), the number (P < 0.001, 1.42 ± 1.69 vs. 1.18 ± 1.80 vs. 0.18 ± 0.64), the positive rate (P < 0.001, 59.0% vs. 46.7% vs. 11.3%) and therapeutic value index (43.3 vs. 14.5 vs. 8.0) were significantly higher in the DM < 30 mm group. By subdivision using the DM distance of 30 mm, more segmented prognostic stratifications were possible (P < 0.001).

Conclusions: A DM of less than 30 mm could be a surrogate marker of poor RFS, especially increasing nodal recurrence. More intensive treatment strategies, including lymphadenectomy and chemotherapy, are needed for patients with this condition.

Keywords: Distal surgical margin; Gastric cancer; Lymph node metastasis; Recurrence-free survival.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Enrolled patients. A total of 559 patients underwent curative distal gastrectomy with lymphadenectomy between January 2008 and June 2018. Of these, 144 patients were excluded from this study. Thus, data from 415 patients were obtained from their hospital records and retrospectively analyzed
Fig. 2
Fig. 2
Comparisons of survival curves according to the distal resection margin (DM) distance. A Comparisons of overall survival (OS) and recurrence-free survival (RFS) in gastric cancer patients who underwent distal gastrectomy. B Comparisons of OS and RFS in early gastric cancer patients who underwent distal gastrectomy. C Comparisons of OS and RFS in advanced gastric cancer patients who underwent distal gastrectomy
Fig. 3
Fig. 3
Comparisons of the incidence of lymph node metastasis between advanced gastric cancer (GC) patients with a distal resection margin (DM) distance ≥ 30 mm and a DM distance < 30 mm. A In advanced GC, there was a higher incidence of lymph node metastasis at station No.6 in the DM distance < 30 mm group compared to the DM distance ≥ 30 mm. B The number of lymph node metastases at station No.6 was higher in the DM distance < 30 mm group compared to the DM distance ≥ 30 mm and the DM distance ≤ 50 mm group, and the DM > 50 mm group
Fig. 4
Fig. 4
Recurrence-free survival curves with combinations of the staging system of the Japanese classification of gastric carcinoma (JCGC) and the distal resection margin (DM) distance. Greater segmented prognostic stratification was possible with combinations of the staging system in JCGC and using a DM distance cut-off value of 30 mm (RFS; pStage IB, DM < 30 mm vs. pStage IB, DM ≥ 30 mm, vs. pStage II, DM < 30 mm vs. pStage II, DM ≥ 30 mm vs. pStage III, DM < 30 mm vs. pStage III, DM ≥ 30 mm = 94.1% vs. 93.2% vs. 73.0% vs. 86.4% vs. 35.3% vs. 57.1%, P < 0.001)
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