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. 2021 Jul;91(7-8):E465-E473.
doi: 10.1111/ans.16937. Epub 2021 May 20.

Influence of positive margins on tumour recurrence and overall survival after gastrectomy for gastric cancer

Luz Divina Juez  1   2 , Alberto G Barranquero  1   2 , Pablo Priego  1   2 , Marta Cuadrado  1   2 , Luis Blázquez  1   2 , Silvia Sánchez-Picot  1   2 , José María Fernández-Cebrián  1   2 , Julio Galindo  1   2
Affiliations

Influence of positive margins on tumour recurrence and overall survival after gastrectomy for gastric cancer

Luz Divina Juez et al. ANZ J Surg. 2021 Jul.

Abstract

Background: Incidence of positive surgical margins after curative gastrectomy ranges from 1% to 20%. It has been suggested that positive surgical margin is an adverse prognosis factor, with a higher local recurrence and worse overall survival (OS). However, the management of these patients remains unclear.

Methods: A total of 267 patients who underwent gastrectomy with curative intent between January 2010 and December 2018 in our centre were enrolled in this study. Post-operative histological analysis revealed positive resection margins in 18 patients (8%). Clinicopathological features and outcome of patients undergoing gastrectomy with negative and positive margins were compared.

Results: Patients with positive margins were associated with higher American Joint Committee on Cancer (AJCC) stage, T stage, N stage, median number of positive nodes, diffuse Lauren type, whole stomach involved and poorly differentiated tumours. Local recurrence was described in 50% of cases with positive margins. The multivariate analysis demonstrated that the TNM stage was the only independent prognostic factor associated with recurrence. OS for positive margins at 1, 3 and 5 years was 75%, 57% and 26%, respectively. The median survival in patients with positive margins was 38.33 versus 81.17 months for R0 patients (p = 0.027). Multivariate analysis showed that age (hazard ratio [HR] 1.041, 95% confidence interval [CI] 1.02-1.07, sex (HR 2.00, 95% CI 1.22-3.30) and TNM stage (p < 0.001) were independent factors of OS.

Conclusion: Positive resection margin was an indication of advanced and more aggressive disease rather than an independent prognosis factor for OS or recurrence in gastric cancer.

Keywords: R1; gastrectomy; gastric cancer; overall survival; positive margins; prognosis; recurrence.

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