Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.
Gastric Cancer. 2012 Sep;15 Suppl 1:S116-24. doi: 10.1007/s10120-011-0112-7. Epub 2011 Dec 3.
Complete resection is the only definitive treatment available for gastric cancer. Factors associated with positive margins and their survival effects have been the subject of many studies, but the appropriate management for these patients is still debated. The objective of this review is to examine positive margins after gastric cancer resections by exploring predictive factors, impact on survival, and optimal strategies for re-resection.
A systematic electronic literature search was conducted using Medline and EMBASE from January 1, 1998, to December 31, 2009. Studies on gastric or gastroesophageal junction adenocarcinoma that either investigated the predictors for positive margin or employed multivariate methods to analyze the survival effects of positive margins were selected.
Twenty-two studies incorporating 19355 patients were included in this review. Positive margins were associated with larger tumor size, deeper wall penetration, more extensive gastric involvement, greater nodal involvement, higher stage, diffuse histology, higher Borrmann type, lymphatic vessel involvement, and total gastrectomy. Patient survival was independently associated with margin status, and this survival effect was more prominent in early cancers in most studies that performed subgroup analyses.
The probability of acquiring positive margins is highly dependent on the biology and the extent of the tumor. There is a significant negative effect on survival, which is more prominent in cancers at early stages, making re-resection or a second operation important. Patients with more advanced disease can be offered more extensive surgery to remove disease, but this should be balanced against the risks of more extensive resections.
完全切除是胃癌唯一的确定性治疗方法。与阳性切缘及其生存影响相关的因素已经成为许多研究的主题，但这些患者的适当治疗仍存在争议。本综述的目的是通过探讨阳性切缘的预测因素、对生存的影响以及再次切除的最佳策略，来研究胃癌切除术后的阳性切缘。
使用 Medline 和 EMBASE 从 1998 年 1 月 1 日至 2009 年 12 月 31 日进行了系统的电子文献检索。选择了研究胃或胃食管交界处腺癌的阳性切缘预测因素或采用多变量方法分析阳性切缘对生存影响的研究。
本综述共纳入了 22 项研究，共计 19355 例患者。阳性切缘与肿瘤较大、壁浸润较深、胃受累较广、淋巴结受累较多、分期较高、弥漫性组织学、较高的 Borrmann 类型、淋巴管受累和全胃切除术有关。患者的生存与切缘状态独立相关，并且在大多数进行亚组分析的研究中，这一生存效应在早期癌症中更为明显。
获得阳性切缘的概率高度取决于肿瘤的生物学特性和肿瘤的侵袭范围。阳性切缘对生存有显著的负面影响，在早期癌症中更为明显，这使得再次切除或再次手术变得很重要。对于更晚期的疾病患者，可以提供更广泛的手术来清除疾病，但这需要权衡更广泛切除的风险。
