Does Resection Line Involvement Affect Prognosis in Early Gastric Cancer Patients? An Italian Multicentric Study

• Published in: World journal of surgery Vol. 30; no. 4; pp. 585 - 589
• Main Authors: Morgagni, Paolo, Garcea, Domenico, Marrelli, Daniele, de Manzoni, Giovanni, Natalini, Giovanni, Kurihara, Hayato, Marchet, Alberto, Vittimberga, Giovanni, Saragoni, Luca, Roviello, Franco, Leo, Alberto Di, De Santis, Francesco, Panizza, Valerio, Nitti, Donato
• Format: Journal Article
• Language: English
• Published: New York Springer‐Verlag 01-04-2006; Springer; Springer Nature B.V
• Subjects: Adult; Biological and medical sciences; Cancer; Complications; Duodenum - pathology; Duodenum - surgery; Early Gastric Cancer; Female; Gastrectomy - methods; Gastric Cancer; Gastric Cancer Patient; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Lymph Node Excision; Lymph nodes; Lymphatic Metastasis; Macroscopic Type; Male; Medical prognosis; Medical sciences; Metastases; Middle Aged; Neoplasm Staging; Neoplasm, Residual - mortality; Neoplasm, Residual - pathology; Patients; Postoperative Complications - mortality; Postoperative Complications - pathology; Prognosis; Resection Line; Stomach - pathology; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Rate; Tumors; Italy; Europe; Human; Prognosis; Multicenter study; Patient; Surgical resection; Malignant tumor; Stomach cancer; Medicine; Treatment; Surgery; Digestive diseases; Early; Gastric disease
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-005-7975-x

Background
Resection line involvement has been indicated as an important prognostic factor for gastric cancer. Its late detection renders the choice of treatment difficult for surgeons.
Materials and Methods
We describe the multicenter experience of a group of 11 patients with early gastric carcinoma (EGC) and positive resection confirmed at histological examination who did not undergo surgical retreatment for reasons of associated disease, surgical considerations on duodenal stump, or patient refusal.
Results
The gastric margin was involved in 4 patients, and 7 patients had duodenal resection line involvement. No surgical complications or postoperative deaths were observed. Five and 8‐year survival was 100% and 86%, respectively. The only patient who relapsed did not have lymph node involvement and died from liver metastases, without local recurrence.
Conclusions
It is sometimes difficult to accurately define the resection line in gastric cancer surgery, especially in the early stages of disease, but because of the strongly negative prognostic value of an infiltrated margin, frozen sections are recommended if neoplastic invasion is suspected and a new resection is always recommended if possible. Nevertheless, the good prognosis of resected EGC patients with resection line involvement must be considered before submitting patients with associated diseases to radical surgical retreatment.