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Abstract
Purpose
The purpose of this study was to analyze the clinical courses of patients with gastric cancer and positive resection margins after a gastrectomy for gastric cancer who did not undergo subsequent surgery.
Materials and Methods
Among 4,452 patients who underwent surgery for gastric cancer from January 2001 to December 2007, 20 patients with positive resection margins after gastrectomy for gastric cancer who did not undergo subsequent surgery were included. The recurrence patterns were confirmed by postoperative computed tomography and gastroscopy, which were performed on a planned schedule. All recurrence patterns after gastrectomy were classified as loco-regional, peritoneal, or distant metastases.
Results
The patients with confirmed recurrence all had advanced stage cancer (III-IV), and the recurrence sites were variable. However, peritoneal and distant recurrences were more common than loco-regional recurrences. The patients with loco-regional recurrence also had peritoneal and/or distant recurrence.
Conclusions
Patients with gastric cancer and a positive resection margin showed more frequent peritoneal and distant metastases than loco-regional recurrence. In addition, patients with loco-regional recurrence also had peritoneal and distant recurrence. A positive resection margin of gastric cancer was related with poor histological differentiation, diffuse type, and advanced stage (III-IV).
Figures and Tables
Table 1
The clinicopathologic features of 20 patients with a positive resection margin after gastrectomy for gastric cancer
Table 2
The recurrence or progression pattern of 20 patients with a positive resection margin
LADG = laparoscopy assisted distal gastrectomy; n = no; PG = proximal gastrectomy; BI = subtotal gastrectomy with Billroth-I anastomosis; CT = chemotherapy; TG = total gastrectomy; RT = radiotherapy; y = yes; BII = Billroth-II anastomosis; *Post operative mortality case; †Patient who was not followed up by postoperative CT and gastroscopy
References
1. 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.
2. Bozzetti F, Bonfanti G, Bufalino R, Menotti V, Persano S, Andreola S, et al. Adequacy of margins of resection in gastrectomy for cancer. Ann Surg. 1982. 196:685–690.
3. Kwon SJ. Clinical significance of tumor infiltration at the resection margin in gastric cancer surgery. J Korean Gastric Cancer Assoc. 2001. 1:24–31.
4. Ha TK, Kwon SJ. Clinical importance of the resection margin distance in gastric cancer patients. J Korean Gastric Cancer Assoc. 2006. 6:277–283.
5. Practice Guideline in SMC Cancer Center. 2006. 6–7.
6. Yokota T, Kunii Y, Teshima S, Yamada Y, Saito T, Takahashi M, et al. Clinicopathologic prognostic features in patients with gastric cancer associated with esophageal or duodenal invasion. Ups J Med Sci. 1999. 104:217–229.
7. Tsujitani S, Okuyama T, Orita H, Kakeji Y, Maehara Y, Sugimachi K, et al. Margins of resection of the esophagus for gastric cancer with esophageal invasion. Hepatogastroenterology. 1995. 42:873–877.
8. Roviello F, Rossi S, Marrelli D, Pedrazzani C, Corso G, Vindigni C, et al. Number of lymph node metastases and its prognostic significance in early gastric cancer: a multicenter Italian study. J Surg Oncol. 2006. 94:275–280.
9. Namikawa T, Hanazaki K. Clinicopathological features of early gastric cancer with duodenal invasion. World J Gastroenterol. 2009. 15:2309–2313.
10. Kakeji Y, Tsujitani S, Baba H, Moriguchi S, Mori M, Maehara Y, et al. Clinicopathologic features and prognostic significance of duodenal invasion in patients with distal gastric carcinoma. Cancer. 1991. 68:380–384.
11. Kakeji Y, Korenaga D, Baba H, Watanabe A, Tsujitani S, Maehara Y, et al. Surgical treatment of patients with gastric carcinoma and duodenal invasion. J Surg Oncol. 1995. 59:215–219.
12. Morgagni P, Garcea D, Marrelli D, de Manzoni G, Natalini G, Kurihara H, et al. Does resection line involvement affect prognosis in early gastric cancer patients? An Italian multicentric study. World J Surg. 2006. 30:585–589.
13. 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.
14. 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.
15. Sun Z, Li DM, Wang ZN, Huang BJ, Xu Y, Li K, et al. Prognostic significance of microscopic positive margins for gastric cancer patients with potentially curative resection. Ann Surg Oncol. 2009. 16:3028–3037.
16. 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.
17. 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.
18. Cascinu S, Giordani P, Catalano V, Agostinelli R, Catalano G. Resection-line involvement in gastric cancer patients undergoing curative resections: implications for clinical management. Jpn J Clin Oncol. 1999. 29:291–293.
19. Cho BC, Jeung HC, Choi HJ, Rha SY, Hyung WJ, Cheong JH, et al. Prognostic impact of resection margin involvement after extended (D2/D3) gastrectomy for advanced gastric cancer: a 15-year experience at a single institute. J Surg Oncol. 2007. 95:461–468.
20. Morgagni P, Garcea D, Marrelli D, De Manzoni G, Natalini G, Kurihara H, et al. Resection line involvement after gastric cancer surgery: clinical outcome in nonsurgically retreated patients. World J Surg. 2008. 32:2661–2667.
21. D'Angelica M, Gonen M, Brennan MF, Tumbull AD, Bains M, Karpeh MS. Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg. 2004. 240:808–816.
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