Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, 8-31, Ariake 3-chome, Koto-ku, Tokyo, 135-8550, Japan.
Gastric Cancer. 2022 Sep;25(5):973-981. doi: 10.1007/s10120-022-01304-x. Epub 2022 May 26.
In proximal gastrectomy (PG), a longer distal margin (DM) length should be maintained to obtain a pathologically negative DM. However, a shorter DM length is preferred to preserve a large remnant stomach for favorable postoperative outcomes. Evidence regarding the minimum DM length to ensure a pathologically negative DM is useful.
Patients who underwent PG or total gastrectomy for cT1N0M0 gastric cancer limited to the upper third were enrolled. A new parameter, ΔDM, which corresponded to the pathological extension distal to the gross tumor boundary towards the resection stump, was evaluated. The maximum ΔDM, which is the length ensuring a pathologically negative DM, was first determined. Furthermore, the possible incidences of pathologically positive DM were calculated for each pathological type and clinical tumor (cTumor) size.
Of 361 patients eligible for this study, 190 and 171 were assigned to differentiated (Dif) and undifferentiated types (Und), respectively. The maximum ΔDM was 30 and 40 mm in Dif and Und, respectively. Considering a correlation between cTumor size and ΔDM, and possible incidences of pathologically positive DM, 10, 20, and 30 mm were the minimal gross DM lengths in Dif when cTumor size was ≤ 15 mm, > 15 and ≤ 50 mm, and > 50 mm, respectively. In Und, the incidences of pathologically positive DM were 0.59% and 2.3% for gross DM lengths of 30 and 20 mm, respectively.
The minimum DM lengths to ensure a pathologically negative DM in PG are proposed according to the pathological type of early upper gastric cancer.
在近端胃切除术（PG）中，为了获得病理阴性的远端切缘（DM），应保持较长的远端切缘长度。然而，为了获得良好的术后结果，更倾向于保持较大的残胃，因此较短的 DM 长度是可取的。关于确保病理阴性 DM 的最小 DM 长度的证据是有用的。
纳入了因局限于胃上部的 cT1N0M0 期胃癌而接受 PG 或全胃切除术的患者。评估了一个新的参数 ΔDM，它对应于大体肿瘤边界向切除残端延伸的病理远处延伸。首先确定了保证病理阴性 DM 的最大 ΔDM。此外，还计算了每种病理类型和临床肿瘤（cTumor）大小的病理阳性 DM 的可能发生率。
在符合本研究条件的 361 例患者中，190 例和 171 例患者分别被分配到分化型（Dif）和未分化型（Und）。Dif 和 Und 的最大 ΔDM 分别为 30 和 40mm。考虑到 cTumor 大小与 ΔDM 之间的相关性以及病理阳性 DM 的可能发生率，当 cTumor 大小为≤15mm、>15mm 且≤50mm 和>50mm 时，Dif 中 10、20 和 30mm 分别是最小的大体 DM 长度。在 Und 中，对于 30mm 和 20mm 的大体 DM 长度，病理阳性 DM 的发生率分别为 0.59%和 2.3%。
根据早期胃上部癌的病理类型，提出了 PG 中确保病理阴性 DM 的最小 DM 长度。
