Department of Surgery, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Department of Surgery, Bravis Hospital, Roosendaal, The Netherlands.
Ann Surg Oncol. 2019 Jul;26(7):2222-2233. doi: 10.1245/s10434-019-07381-0. Epub 2019 Apr 22.
Radical gastrectomy is the cornerstone of the treatment of locally advanced gastric cancer. This study was designed to evaluate factors associated with a tumor-positive resection margin after gastrectomy and to evaluate the influence of hospital volume.
In this Dutch cohort study, patients with junctional or gastric cancer who underwent curative gastrectomy between 2011 and 2017 were included. The primary outcome was incomplete tumor removal after the operation defined as the microscopic presence of tumor cells at the resection margin. The association of patient and disease characteristics with incomplete tumor removal was tested with multivariable regression analysis. The association of annual hospital volume with incomplete tumor removal was tested and adjusted for the patient- and disease characteristics.
In total, 2799 patients were included. Incomplete tumor removal was seen in 265 (9.5%) patients. Factors associated with incomplete tumor removal were: tumor located in the entire stomach (odds ratio (OR) [95% confidence interval (CI): 3.38 [1.91-5.96] reference: gastroesophageal junction), cT3, cT4, cTx (1.75 [1.20-2.56], 2.63 [1.47-4.70], 1.60 [1.03-2.48], reference: cT0-2), pN+ (2.73 [1.96-3.80], reference: pN-), and diffuse and unknown histological subtype (3.15 [2.14-4.46] and 2.05 [1.34-3.13], reference: intestinal). Unknown differentiation grade was associated with complete tumor removal (0.50 [0.30-0.83], reference: poor/undifferentiated). Compared with a hospital volume of < 20 resections/year, 20-39, and > 39 resections were associated with lower probability for incomplete tumor removal (OR 0.56 [0.42-0.76] and 0.34 [0.18-0.64]).
Tumor location, cT, pN, histological subtype, and tumor differentiation are associated with incomplete tumor removal. The association of incomplete tumor removal with an annual hospital volume of < 20 resections may underline the need for further centralization of gastric cancer care in the Netherlands.
根治性胃切除术是局部进展期胃癌治疗的基石。本研究旨在评估胃切除术后肿瘤阳性切缘的相关因素，并评估医院容量的影响。
在这项荷兰队列研究中，纳入了 2011 年至 2017 年间接受根治性胃切除术的交界性或胃癌患者。主要结局为术后不完全肿瘤切除，定义为切缘处有肿瘤细胞的显微镜下存在。采用多变量回归分析检测患者和疾病特征与不完全肿瘤切除的关系。检测并调整了医院年容量与不完全肿瘤切除的相关性。
共纳入 2799 例患者。265 例（9.5%）患者存在不完全肿瘤切除。与不完全肿瘤切除相关的因素包括：肿瘤位于整个胃（比值比（OR）[95%置信区间（CI）：3.38[1.91-5.96]，参考：胃食管交界处），cT3、cT4、cTx（1.75[1.20-2.56]、2.63[1.47-4.70]、1.60[1.03-2.48]，参考：cT0-2）、pN+（2.73[1.96-3.80]，参考：pN-）和弥漫性和未知组织学亚型（3.15[2.14-4.46]和 2.05[1.34-3.13]，参考：肠型）。未知分化程度与完全肿瘤切除相关（0.50[0.30-0.83]，参考：低/未分化）。与医院年手术量<20 例相比，20-39 例和>39 例与不完全肿瘤切除的概率较低相关（OR 0.56[0.42-0.76]和 0.34[0.18-0.64]）。
肿瘤位置、cT、pN、组织学亚型和肿瘤分化与不完全肿瘤切除有关。不完全肿瘤切除与<20 例/年的医院年手术量相关，这可能表明荷兰需要进一步集中胃癌治疗。
