Minimum resection length to ensure a pathologically negative distal margin and the preservation of a larger remnant stomach in proximal gastrectomy for early upper gastric cancer
Minimum resection length to ensure a pathologically negative distal margin and the preservation of a larger remnant stomach in proximal gastrectomy for early upper gastric cancer
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DOI：
10.1007/s10120-022-01304-x
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发表时间：
2022-05-26
期刊：
影响因子：
7.4
通讯作者：
Nunobe, Souya
中科院分区：
文献类型：
--
作者：
Koterazawa, Yasufumi;Ohashi, Manabu;Nunobe, Souya
背景：在近端胃切除术（PG）中，应保持较长的远端切缘（DM）长度，以获得病理阴性的DM。然而，较短的DM长度是为了保留较大的残胃，以获得良好的术后结果。关于最小DM长度以确保病理阴性DM的证据是有用的。方法入选仅限前三分之一的cT1N0M0型胃癌行PG或全胃切除术的患者。一个新的参数，Delta DM，对应于病理延伸远端大体肿瘤边界向切除残端，进行了评估。首先确定最大Delta DM，即确保病理阴性DM的长度。此外，计算各病理类型和临床肿瘤（cTumor）大小的病理阳性DM的可能发生率。在361例符合研究条件的患者中，分别有190例和171例被划分为分化型（Dif）和未分化型（Und）。Dif和Und的最大DM分别为30和40 mm。考虑到cTumor大小与Delta DM之间的相关性，以及病理阳性DM的可能发生率，当cTumor大小分别为15和50 mm时，10、20和30 mm是Dif中最小的总DM长度。在Und， DM总长度为30和20 mm时，DM病理阳性的发生率分别为0.59%和2.3%。结论根据早期上胃癌的病理类型，提出了保证PG病理阴性DM的最小DM长度。
Background In proximal gastrectomy (PG), a longer distal margin (DM) length should be maintained to obtain a pathologically negative DM. However, a shorter DM length is preferred to preserve a large remnant stomach for favorable postoperative outcomes. Evidence regarding the minimum DM length to ensure a pathologically negative DM is useful. Methods Patients who underwent PG or total gastrectomy for cT1N0M0 gastric cancer limited to the upper third were enrolled. A new parameter, Delta DM, which corresponded to the pathological extension distal to the gross tumor boundary towards the resection stump, was evaluated. The maximum Delta DM, which is the length ensuring a pathologically negative DM, was first determined. Furthermore, the possible incidences of pathologically positive DM were calculated for each pathological type and clinical tumor (cTumor) size. Results Of 361 patients eligible for this study, 190 and 171 were assigned to differentiated (Dif) and undifferentiated types (Und), respectively. The maximum Delta DM was 30 and 40 mm in Dif and Und, respectively. Considering a correlation between cTumor size and Delta DM, and possible incidences of pathologically positive DM, 10, 20, and 30 mm were the minimal gross DM lengths in Dif when cTumor size was 15 and 50 mm, respectively. In Und, the incidences of pathologically positive DM were 0.59% and 2.3% for gross DM lengths of 30 and 20 mm, respectively. Conclusion The minimum DM lengths to ensure a pathologically negative DM in PG are proposed according to the pathological type of early upper gastric cancer.