Wang Shang-Yu, Yeh Chun-Nan, Lee Hsiang-Lin, Liu Yu-Yin, Chao Tzu-Chieh, Hwang Tsann-Long, Jan Yi-Yin, Chen Miin-Fu
Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Ann Surg Oncol. 2009 Oct;16(10):2738-43. doi: 10.1245/s10434-009-0616-0. Epub 2009 Jul 28.
The clinical impact of positive surgical margin on the overall survival and recurrence pattern for gastric cancer (GC) patients undergoing intension curative resection has not yet been well investigated.
The clinical features of 1,565 patients with histologically proven GC who underwent intension curative resection from 1994 to 2004 were retrospectively reviewed. Among them, 129 (8.2%) had positive microscopic resection margin. The clinicopathological features and the outcome of 1,436 GC patients undergoing gastrectomy with negative resection margin were used for comparison.
GC patients who underwent gastrectomy with higher T, N stage, and tumor size larger than 5 cm tended to have positive resection margin when compared with those with negative margin. Median follow-up duration for the 1,565 GC patients who underwent intension curative resection was 28.6 months. The overall survival (OS) rate significantly decreased when the patients had positive resection margin, irrespective of different stages. When GC patients underwent gastrectomy with positive resection margin, positive nodal metastasis determined the worst OS. Distant metastasis was the most common site of recurrence, followed by peritoneal and locoregional recurrence.
Aggressive tumor biology might be the main factor contributing to positive microscopic resection margin after gastrectomy. Positive resection margin had a definite unfavorable impact on the OS of gastric cancer patients undergoing gastrectomy. When GC patients underwent gastrectomy with positive resection margin, positive nodal metastasis determined the worst OS, and distant metastasis was the most common site of recurrence.
对于接受根治性切除的胃癌（GC）患者，手术切缘阳性对总生存期和复发模式的临床影响尚未得到充分研究。
回顾性分析了1994年至2004年间1565例经组织学证实为GC且接受根治性切除患者的临床特征。其中，129例（8.2%）显微镜下切缘阳性。将1436例切缘阴性的GC患者行胃切除术后的临床病理特征及结果作为对照。
与切缘阴性的患者相比，接受胃切除术的GC患者若T、N分期较高且肿瘤大小大于5 cm，则切缘阳性的可能性更大。1565例行根治性切除的GC患者的中位随访时间为 28.6个月。无论处于何分期，切缘阳性患者的总生存期（OS）率均显著降低。当GC患者行切缘阳性的胃切除术时，阳性淋巴结转移预示着最差的总生存期。远处转移是最常见的复发部位，其次是腹膜和局部区域复发。
侵袭性肿瘤生物学特性可能是胃切除术后显微镜下切缘阳性的主要因素。切缘阳性对接受胃切除术的胃癌患者的总生存期有明确的不利影响。当GC患者行切缘阳性的胃切除术时，阳性淋巴结转移预示着最差的总生存期，远处转移是最常见的复发部位。
