Resection-line Involvement in Gastric Cancer Patients Undergoing Curative Resections: Implications for Clinical Management

Cascinu, Stefano; Giordani, Paolo; Catalano, Vincenzo; Agostinelli, Romina; Catalano, Giuseppina

doi:10.1093/jjco/29.6.291

Cited by 44 publications

(53 citation statements)

References 7 publications

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“…The microscopic positive margin was found in 2.8% of gastric cancer patients in the present study (14.5% of all patients including non-curative cases; data not shown), which is consistent with previous studies reporting the rates from 1% to 20% [7][8][9][10][11]. Concerning the prognostic impact of surgical margin status, previous reports demonstrated that a positive margin was associated with a worse outcome [7,12,13].…”

Section: Discussionsupporting

confidence: 92%

Prognostic impact of microscopic positive margin in gastric cancer patients

Nagata

Ichikawa

Komatsu

et al. 2011

Journal of Surgical Oncology

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Section: Discussionsupporting

confidence: 92%

Prognostic impact of microscopic positive margin in gastric cancer patients

Nagata

Ichikawa

Komatsu

et al. 2011

Journal of Surgical Oncology

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“…Converting this continuous variable in a binary one, we find that 72 % of group A patients had a tumor larger than 4 cm in comparison with 36 % of group B patients (p \ 0.001). Similarly to the previous analysis, also for this subgroup a significantly higher incidence of tumor invasion, vascular infiltration, and lymphatic infiltration was found in group A patients (26,22, and 26 %, respectively) in comparison with group B patients (10 %, p = 0.002; 11 %, p = 0.037; and 9 %, p = 0.001, respectively). The presence of lymph node metastases was higher in patients with RM involvement than in patients with negative RMs (87 % vs 74 %, p = 0.03).…”

Section: Risk Factor Analysis For T2-t4 Lauren Diffuse/mixed Pattern supporting

confidence: 85%

“…Despite the fact that the real prognostic impact of positive RMs is still a matter of discussion, most authors [1,2,4,21,22] suggest that, in the case of R1 resection, a surgical retreatment of the patient aiming to achieve radical resection (if possible) should always be considered, in order to ensure optimal prognostic results. Lee et al [23] showed that the OS rate and the recurrence rate are not changed if R0 resection is achieved by performing additional resection for positive RMs.…”

Section: Discussionmentioning

confidence: 99%

Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study

et al. 2016

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Background Resection margin (RM) involvement is associated with negative prognosis after gastrectomy. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is timeconsuming and resource-consuming. The aim of this study was to assess risk factors associated with RM involvement to identify patients who would benefit from IFS analysis. Methods We retrospectively analyzed patients who underwent gastrectomy with curative intent for gastric or esophagogastric junction (EGJ) cancer from 2000 to 2014 in six Italian hospitals. RM status was assessed by IFS analysis and/or definitive histopathology examination. A set of 21 potential risk factors were compared in a multivariate analysis between patients with positive RMs on IFS analysis or definitive histopathology examination and a control cohort of similar patients with negative RMs, with the samples stratified into three subgroups (T1, T2-T4 Lauren intestinal pattern, T2-T4 Lauren diffuse/mixed pattern). Results One hundred forty-five patients had positive RMs. Survival was significantly worse in positive RM patients than in negative RM patients (89.5 months vs 28.9 months). Multivariate analysis showed that in T1 cancers a margin distance of less than 2 cm is a risk factor for RM involvement (odds ratio 15.7), in T2-T4 intestinal pattern cancers, serosa invasion (odds ratio 6.0), EGJ location (odds ratio 4.1), and a margin distance of less than 3 cm (odds ratio 4.0) are independent risk factors, and in T2-T4 diffuse/mixed pattern cancers, lymphatic infiltration (odds ratio 4.2), tumor diameter greater than 4 cm (odds ratio 3.5), EGJ location (odds ratio 2.8), and serosa invasion (odds ratio 2.2) are independent risk factors. Conclusions Survival after gastrectomy is negatively affected by positive RMs. IFS analysis should be routinely used in patients with a high risk of positive RMs, especially in diffuse pattern cancers.

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“…Multiple studies have demonstrated that microscopically positive (R1) margins after resection can be associated with worse prognosis, although the prognostic effect can differ between early-and advanced-stage gc [25][26][27][28][29][30][31] . On multivariate analysis, the predictors for a positive margin include higher T stage, higher N stage, larger tumour size, and diffuse histologic type 24,[28][29][30] .…”

Section: Summary Of Evidencementioning

confidence: 99%

Report from the 17th Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Edmonton, Alberta; 11–12 September 2015

et al. 2016

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The 17th annual Western Canadian Gastrointestinal Cancer Consensus Conference (wcgccc) was held in Edmonton, Alberta, 11-12 September 2015. The wcgccc is an interactive multidisciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management of gastric cancer.

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Resection-line Involvement in Gastric Cancer Patients Undergoing Curative Resections: Implications for Clinical Management

Abstract: Our data suggest, in the case of positive margins, that re-laparatomy should be considered only for patients with N0 stage disease, while patients with metastatic lymph nodes should be watched closely without the need for a more aggressive surgical approach.

Cited by 44 publications

References 7 publications

Prognostic impact of microscopic positive margin in gastric cancer patients

Prognostic impact of microscopic positive margin in gastric cancer patients

Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study

Report from the 17th Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Edmonton, Alberta; 11–12 September 2015

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