Massimiliano Bissolati1, Matteo Desio2, Fausto Rosa3, Stefano Rausei4, Daniele Marrelli5, Gian Luca Baiocchi6, Giovanni De Manzoni7, Damiano Chiari2, Giovanni Guarneri2, Fabio Pacelli3, Lorenzo De Franco5, Sarah Molfino6, Chiara Cipollari7, Elena Orsenigo2. 1. Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. maxbisso@gmail.com. 2. Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. 3. Digestive Surgery, A. Gemelli Hospital, Catholic University, Rome, Italy. 4. Department of Surgical Sciences and Human Morphology, First Division of Surgery, Insubria University, Varese, Italy. 5. Surgical Oncology Unit, University of Siena, Siena, Italy. 6. Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy. 7. Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy.
Abstract
BACKGROUND: Resection margin (RM) involvement is associated with negative prognosis after gastrectomy. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is time-consuming and resource-consuming. The aim of this study was to assess risk factors associated with RM involvement to identify patients who would benefit from IFS analysis. METHODS: We retrospectively analyzed patients who underwent gastrectomy with curative intent for gastric or esophagogastric junction (EGJ) cancer from 2000 to 2014 in six Italian hospitals. RM status was assessed by IFS analysis and/or definitive histopathology examination. A set of 21 potential risk factors were compared in a multivariate analysis between patients with positive RMs on IFS analysis or definitive histopathology examination and a control cohort of similar patients with negative RMs, with the samples stratified into three subgroups (T1, T2-T4 Lauren intestinal pattern, T2-T4 Lauren diffuse/mixed pattern). RESULTS: One hundred forty-five patients had positive RMs. Survival was significantly worse in positive RM patients than in negative RM patients (89.5 months vs 28.9 months). Multivariate analysis showed that in T1 cancers a margin distance of less than 2 cm is a risk factor for RM involvement (odds ratio 15.7), in T2-T4 intestinal pattern cancers, serosa invasion (odds ratio 6.0), EGJ location (odds ratio 4.1), and a margin distance of less than 3 cm (odds ratio 4.0) are independent risk factors, and in T2-T4 diffuse/mixed pattern cancers, lymphatic infiltration (odds ratio 4.2), tumor diameter greater than 4 cm (odds ratio 3.5), EGJ location (odds ratio 2.8), and serosa invasion (odds ratio 2.2) are independent risk factors. CONCLUSIONS: Survival after gastrectomy is negatively affected by positive RMs. IFS analysis should be routinely used in patients with a high risk of positive RMs, especially in diffuse pattern cancers.
BACKGROUND: Resection margin (RM) involvement is associated with negative prognosis after gastrectomy. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is time-consuming and resource-consuming. The aim of this study was to assess risk factors associated with RM involvement to identify patients who would benefit from IFS analysis. METHODS: We retrospectively analyzed patients who underwent gastrectomy with curative intent for gastric or esophagogastric junction (EGJ) cancer from 2000 to 2014 in six Italian hospitals. RM status was assessed by IFS analysis and/or definitive histopathology examination. A set of 21 potential risk factors were compared in a multivariate analysis between patients with positive RMs on IFS analysis or definitive histopathology examination and a control cohort of similar patients with negative RMs, with the samples stratified into three subgroups (T1, T2-T4 Lauren intestinal pattern, T2-T4 Lauren diffuse/mixed pattern). RESULTS: One hundred forty-five patients had positive RMs. Survival was significantly worse in positive RM patients than in negative RM patients (89.5 months vs 28.9 months). Multivariate analysis showed that in T1 cancers a margin distance of less than 2 cm is a risk factor for RM involvement (odds ratio 15.7), in T2-T4 intestinal pattern cancers, serosa invasion (odds ratio 6.0), EGJ location (odds ratio 4.1), and a margin distance of less than 3 cm (odds ratio 4.0) are independent risk factors, and in T2-T4 diffuse/mixed pattern cancers, lymphatic infiltration (odds ratio 4.2), tumor diameter greater than 4 cm (odds ratio 3.5), EGJ location (odds ratio 2.8), and serosa invasion (odds ratio 2.2) are independent risk factors. CONCLUSIONS: Survival after gastrectomy is negatively affected by positive RMs. IFS analysis should be routinely used in patients with a high risk of positive RMs, especially in diffuse pattern cancers.
Authors: Jung-Woo Woo; Keun Won Ryu; Ji Yeon Park; Bang Wool Eom; Mi Jung Kim; Hong Man Yoon; Sook Ryun Park; Myeong-Cherl Kook; Il Ju Choi; Young-Woo Kim; Young-Iee Park Journal: World J Surg Date: 2014-02 Impact factor: 3.352
Authors: K Nakamura; T Ueyama; T Yao; Z X Xuan; K Ambe; Y Adachi; Y Yakeishi; A Matsukuma; M Enjoji Journal: Cancer Date: 1992-09-01 Impact factor: 6.860
Authors: Leonie R van der Werf; Charlotte Cords; Ivo Arntz; Eric J T Belt; Ivan M Cherepanin; Peter-Paul L O Coene; Erwin van der Harst; Joos Heisterkamp; Barbara S Langenhoff; Bas Lamme; Mark I van Berge Henegouwen; Sjoerd M Lagarde; Bas P L Wijnhoven Journal: Ann Surg Oncol Date: 2019-04-22 Impact factor: 5.344