Hayami Masaru, Ohashi Manabu, Ida Satoshi, Kumagai Koshi, Sano Takeshi, Hiki Naoki, Nunobe Souya
From the Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
Ann Surg Open. 2020 Dec 11;1(2):e026. doi: 10.1097/AS9.0000000000000026. eCollection 2020 Dec.
The objective of this study is to determine a "just enough" gross proximal margin (PM) length to ensure a pathologically negative PM in distal gastrectomy for gastric cancer. There is a discrepancy between the gross and pathological proximal boundaries of gastric cancer. We must transect the stomach maintaining some safety margins to obtain a pathologically negative PM. However, we have no standard to indicate where to transect the stomach.
Patients undergoing distal gastrectomy for gastric cancer were enrolled. A new parameter named ΔPM, which corresponded to the pathological extension proximal to the gross tumor boundary toward the resection stump, was evaluated. The number of patients was counted in each ΔPM range of 1-cm increments. The maximum ΔPM was defined as the first value at which the number of patients became 0, and it was determined as the recommended gross PM length for each disease type.
In cT1, 259 and 330 patients were assigned to differentiated (Dif) and undifferentiated types (Und), respectively. The maximum ΔPM was 20 mm for Dif and 40 mm for Und. In cT2-4, 194 and 490 patients were assigned to the expansive (Exp) and infiltrative (Inf) growth types. The maximum ΔPM was 30 mm for Exp. The maximum ΔPM was 50 mm for Inf of less than 80 mm and 60 mm for Inf of 80 mm or more.
A newly recommended gross PM length to ensure pathologically negative PMs in distal gastrectomy for each gastric cancer type was determined.
本研究的目的是确定一个“足够”的近端切缘（PM）长度，以确保胃癌远端胃切除术中病理切缘为阴性。胃癌的大体和病理近端边界存在差异。我们必须在胃上进行横断并保留一定的安全切缘，以获得病理切缘阴性。然而，我们没有标准来指示在何处横断胃。
纳入接受胃癌远端胃切除术的患者。评估了一个名为ΔPM的新参数，它对应于肿瘤大体边界近端向切除残端的病理延伸。以1厘米的增量在每个ΔPM范围内对患者数量进行计数。将最大ΔPM定义为患者数量变为0的第一个值，并将其确定为每种疾病类型的推荐大体PM长度。
在cT1期，分别有259例和330例患者被分配到分化型（Dif）和未分化型（Und）。Dif的最大ΔPM为20毫米，Und为40毫米。在cT2 - 4期，分别有194例和490例患者被分配到膨胀型（Exp）和浸润型（Inf）生长类型。Exp的最大ΔPM为30毫米。Inf小于80毫米的最大ΔPM为50毫米，Inf为80毫米或以上的最大ΔPM为60毫米。
确定了一种新的推荐大体PM长度，以确保每种胃癌类型在远端胃切除术中病理切缘为阴性。
