Cho Byoung Chul, Jeung Hei Cheul, Choi Hye Jin, Rha Sun Young, Hyung Woo Jin, Cheong Jae Ho, Noh Sung Hoon, Chung Hyun Cheol
Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
J Surg Oncol. 2007 May 1;95(6):461-8. doi: 10.1002/jso.20731.
The aim of this study was to investigate whether microscopic positive margins are detrimental to the outcome of gastric cancer patients treated with extended (D2/3) gastrectomy.
Among 2,740 consecutive patients who had undergone extended gastrectomy for advanced gastric cancer between January 1987 and December 2002, 49 patients (1.8%) had positive resection margins on final histology.
Among 49 patients, 29 (59.2%) had proximal involved margins and 20 (40.8%) had distal involved margins. The median survival time of the positive margin group was 34 months. The negative margin group had a significantly longer median survival time of 69 months (P = 0.025). When both groups of patients were stratified according to nodal stage, a positive resection margin determined a worse prognosis only in patients with node-negative disease (174 months vs. 37 months, P = 0.0001). In patients with nodal metastasis, the median survival time was similar in both groups.
Our results suggest that a positive microscopic margin is associated with a worse outcome in patients with node-negative disease. Therefore, a more aggressive treatment, such as re-operation, is needed in node-negative patients with a positive microscopic disease.
本研究旨在调查显微镜下切缘阳性是否对接受扩大（D2/3）胃切除术的胃癌患者的预后产生不利影响。
在1987年1月至2002年12月期间连续接受扩大胃切除术治疗进展期胃癌的2740例患者中，49例（1.8%）最终组织学检查切缘阳性。
49例患者中，29例（59.2%）近端切缘受累，20例（40.8%）远端切缘受累。切缘阳性组的中位生存时间为34个月。切缘阴性组的中位生存时间显著更长，为69个月（P = 0.025）。当两组患者根据淋巴结分期进行分层时，切缘阳性仅在淋巴结阴性疾病患者中决定了更差的预后（174个月对37个月，P = 0.0001）。在有淋巴结转移的患者中，两组的中位生存时间相似。
我们的结果表明，显微镜下切缘阳性与淋巴结阴性疾病患者的较差预后相关。因此，对于显微镜下疾病阳性的淋巴结阴性患者，需要采取更积极的治疗措施，如再次手术。
