Background

The 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.

Methods

A 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.

Results

Twenty-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).

Conclusion

PRM 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.

中文翻译：

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癌症胃切除术中切缘阳性的危险因素和肿瘤学影响：是否可以通过额外切除来挽救？

背景

阳性切缘 (PRM) 的情况在西方和亚洲国家之间存在显着差异。在西方，PRMs 与晚期疾病和 R1 相关，而在亚洲，PRMs 也被认为是早期疾病，因为胃保护最近被优先考虑。此外，通常切除 PRM 以获得 R0。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 在临床分期 (cStage) I 胃癌腹腔镜胃切除术 (LG) 中的肿瘤学影响。

方法

共有 2121 名在 2007 年至 2015 年间因 cStage I 胃癌接受 LG 的患者入组。比较了有 PRM 的患者（P 组）和没有 PRM 的患者（N 组）的生存结果。此外，使用多变量分析分析预后因素。

结果

27 名患者 (1.3%) 患有 PRM。P组患者病情较重且晚期，P组5年无复发生存率（RFS）比N组差（76.3% vs. 95.1%，P  =0.003）。P 组 pT2 或更深（pT2-4）疾病患者的 5 年 RFS 显着低于 N 组患者（66.7% vs. 89.5%，P  = 0.030），尽管 pT1 患者没有. 似然比检验表明，pT 状态与 PRM 之间存在显着的交互作用（P  = 0.005）。

结论

cStage I 胃癌中的 PRM 与晚期上肢疾病有关。即使在额外切除以获得 R0 后，它仍然是 pT2-4 疾病的独立预后因素。