Symeonidis Dimitrios, Zacharoulis Dimitrios, Petsa Eleana, Samara Athina A, Kissa Labrini, Tepetes Konstantinos
Department of Surgery, University Hospital of Larissa, Larissa, Greece.
Cancer Diagn Progn. 2022 Sep 3;2(5):520-524. doi: 10.21873/cdp.10136. eCollection 2022 Sep-Oct.
A potentially curative treatment scheme for gastric cancer is considered futile without a proper surgical resection. An oncological, surgical resection for gastric cancer prerequisites a proper resection of the stomach, and a D2 lymph node dissection followed by reconstruction of the gastrointestinal tract continuity. Recently, as the favorable impact of organ preserving surgery on functional outcomes has been increasingly appreciated; distal gastrectomy represents a valid alternative to total gastrectomy provided that the proper oncological principles are not violated. However, the appropriateness of distal gastrectomy as a valid type of resection becomes synonymous with achieving a negative proximal resection margin. The purpose of the present study was to assess the optimal distance between the tumor and the resection margin in a gastrectomy with curative intent, performed for gastric cancer, by reviewing the relevant literature. Having in mind, the well documented discrepancy between the gross and the pathologic boundaries of the tumor, pitfalls might be encountered. Current published guidelines have used a "safety distance" i.e., >4 or 5 cm between the proximal macroscopic tumor border and the proximal resection margin in order to guarantee a negative resection margin on pathology. An increased distance of safety is currently proposed in high-risk tumors such as tumors of the diffuse histological type.
如果没有适当的手术切除，一种可能治愈胃癌的治疗方案被认为是无效的。胃癌的肿瘤学手术切除需要对胃进行适当切除，并进行D2淋巴结清扫，随后重建胃肠道连续性。最近，随着保器官手术对功能结局的有利影响越来越受到重视；只要不违反适当的肿瘤学原则，远端胃切除术是全胃切除术的一种有效替代方案。然而，远端胃切除术作为一种有效的切除方式是否合适，就等同于实现近端切缘阴性。本研究的目的是通过回顾相关文献，评估为胃癌进行的根治性胃切除术中肿瘤与切缘之间的最佳距离。考虑到肿瘤大体边界与病理边界之间有充分记录的差异，可能会遇到一些陷阱。目前已发表的指南使用了“安全距离”，即在近端宏观肿瘤边界与近端切缘之间>4或5cm，以确保病理切缘阴性。目前对于弥漫性组织学类型肿瘤等高风险肿瘤，建议增加安全距离。
