Risk factors and oncological impact of positive resection margins in gastrectomy for cancer: are they salvaged by an additional resection?
Risk factors and oncological impact of positive resection margins in gastrectomy for cancer: are they salvaged by an additional resection?
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DOI：
10.1007/s10120-021-01238-w
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发表时间：
2021-08
期刊：
影响因子：
7.4
通讯作者：
Yusuke Muneoka;M. Ohashi;N. Ishizuka;M. Hayami;R. Makuuchi;S. Ida;K. Kumagai;T. Sano;S. Nunobe
中科院分区：
文献类型：
--
作者：
Yusuke Muneoka;M. Ohashi;N. Ishizuka;M. Hayami;R. Makuuchi;S. Ida;K. Kumagai;T. Sano;S. Nunobe
背景切缘阳性的情况在西方国家和亚洲国家之间存在显著差异。在西方，PRM与晚期疾病和R1相关，而在亚洲，PRM也被认为是早期疾病，因为胃保护最近被优先考虑。此外，PRM通常被切除以获得R 0。然而，PRM和额外切除的肿瘤学影响仍不清楚。本研究的目的是评估PRM在腹腔镜胃切除术（LG）的临床阶段（cStage）I gastric cancer.MethodsA的肿瘤学影响，共2121例患者接受LG的cStage I gastric cancer在2007年和2015年之间入组。比较PRM患者（P组）和无PRM患者（N组）的生存结局。此外，预后因素进行了分析，使用多变量analysis.Results27例（1.3%）有PRM。P组患者的病情较N组高，且5年无复发生存率（RFS）较N组低（76.3%vs.95.1%，P = 0.003）。P组中pT 2或更深（pT 2 -4）病变患者的5年RFS显著差于N组（66.7%vs.89.5%，P = 0.030），而pT 1患者的5年RFS无显著差异。Likewise ratio检验显示pT状态与PRM之间存在显著的交互作用（P= 0.005）。即使在额外切除以获得R 0后，它仍然是pT 2 -4疾病的独立预后因素。
BackgroundThe situation of positive resection margins (PRMs) varies notably between Western and Asian countries. In the West, PRMs are associated with advanced disease and R1, whereas in Asia, PRMs are also considered in early disease because stomach preservation was recently prioritized. Furthermore, PRMs are usually resected to obtain R0. However, the oncological impact of PRMs and additional resection remains unclear. The aim of this study is to evaluate the oncological impact of PRMs in laparoscopic gastrectomy (LG) for clinical stage (cStage) I gastric cancer.MethodsA total of 2121 patients who underwent LG for cStage I gastric cancer between 2007 and 2015 were enrolled. Survival outcomes were compared between patients with PRMs (group P) and those without (group N). Furthermore, prognostic factors were analyzed using multivariate analysis.ResultsTwenty-seven patients (1.3%) had PRMs. Patients in group P had upper and more advanced disease, and the 5-year relapse-free survival (RFS) rate was worse in group P compared with group N (76.3% vs. 95.1%,P= 0.003). The 5-year RFS of patients with pT2 or deeper (pT2–4) disease in group P was significantly worse than that of patients in group N (66.7% vs. 89.5%,P= 0.030) although that of patients with pT1 was not. Likelihood ratio tests showed that there was a significant interaction between pT status and PRM (P= 0.005).ConclusionPRM in cStage I gastric cancer is associated with advanced upper disease. It remains an independent prognostic factor in pT2–4 disease even after an additional resection to obtain R0.