Clinicopathologic characteristics of gastric cancer patients with cancer infiltration at surgical margin at gastrectomy.

Although curative surgery is desirable in patients with gastric cancer, tumors adjacent to the esophagogastric and/or gastroduodenal junctions present surgeons with some difficulty in estimating whether or not the lesion has infiltrated beyond the surgical margin. We report herein a retrospective analysis with respect to the clinicopathologic features of the primary lesion and margin positivity for tumor cells. Between 1982 and 1993, 861 gastric cancer patients underwent gastrectomy in our clinics. Of these, 340 had early cancer and the remaining 521 advanced cancer. Cancer infiltration at the surgical margin was determined macroscopically in the fresh resected specimen; re-resection was carried out immediately for positive cases and, subsequently, a rapid histologic examination at the newly-incised edge was carried out intraoperatively. Of the 340 patients with early cancer. 15 (4.4%) had a positive surgical margin which was directly resected successfully. Of the 521 patients with advanced cancer, 73 (14%) had a positive surgical margin and 28 of them had a microscopically negative surgical edge after re-resection; however, 8 others had a positive result at the newly-excised edge after re-resection, and the remaining 37 could not undergo re-resection because of their poor general condition and/or because the tumor had spread to other sites. The positive rate for the final surgical margin was 5.2% (45/861 patients). All of the patients with a positive margin and early cancer had a superficial or excavative type lesion, and 76.7% (56/73 patients) of those with advanced cancer had Borrmann's III or IV type lesion. These findings suggest that in such patients with a tumor adjacent to the esophagogastric and/or gastroduodenal junctions, particular attention should be paid to Borrmann's III or IV lesions in advanced cancer and to superficial or excavated type lesions in early cancer in order to reduce the frequency of positive surgical margin. Additionally, an immediate histologic examination after re-resection is extremely important.