Department of General, Visceral and Transplantat Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Department of Surgery, Clarunis-University Digestive Health Care Center, St. Clara Hospital and University Hospital Basel, Basel, Switzerland.
Ann Surg Oncol. 2024 Oct;31(10):6900-6908. doi: 10.1245/s10434-024-15721-y. Epub 2024 Jul 5.
The risk for recurrence in patients with distal gastric cancer can be reduced by surgical radicality. However, dispute exists about the value of the proposed minimum proximal margin distance (PMD). Here, we assess the prognostic value of the safety distance between the proximal resection margin and the tumor.
This is a single-center cohort study of patients undergoing distal gastrectomy for gastric adenocarcinoma (2001-2021). Cohorts were defined by adequacy of the PMD according to the European Society for Medical Oncology (ESMO) guidelines (≥ 5 cm for intestinal and ≥ 8 cm for diffuse Laurén's subtypes). Overall survival (OS) and time to progression (TTP) were assessed by log-rank and multivariable Cox-regression analyses.
Of 176 patients, 70 (39.8%) had a sufficient PMD. An adequate PMD was associated with cancer of the intestinal subtype (67% vs. 45%, p = 0.010). Estimated 5-year survival was 63% [95% confidence interval (CI) 51-78] and 62% (95% CI 53-73) for adequate and inadequate PMD, respectively. Overall, an adequate PMD was not prognostic for OS (HR 0.81, 95% CI 0.48-1.38) in the multivariable analysis. However, in patients with diffuse subtype, an adequate PMD was associated with improved oncological outcomes (median OS not reached versus 131 months, p = 0.038, median TTP not reached versus 88.0 months, p = 0.003).
Patients with diffuse gastric cancer are at greater risk to undergo resection with an inadequate PMD, which in those patients is associated with worse oncological outcomes. For the intestinal subtype, there was no prognostic association with PMD, indicating that a distal gastrectomy with partial preservation of the gastric function may also be feasible in the setting where an extensive PMD is not achievable.
通过手术根治性切除可降低远端胃癌患者的复发风险。然而，对于建议的近端切缘最小距离（PMD）的价值仍存在争议。在这里，我们评估近端切缘与肿瘤之间安全距离的预后价值。
这是一项单中心队列研究，纳入了 2001 年至 2021 年间接受远端胃切除术治疗胃腺癌的患者。根据欧洲肿瘤内科学会（ESMO）指南（肠型肿瘤的 PMD 应≥5cm，弥漫型Laurén 肿瘤的 PMD 应≥8cm），将患者分为 PMD 充分和不足亚组。通过对数秩和多变量 Cox 回归分析评估总生存（OS）和无进展生存（TTP）。
在 176 例患者中，70 例（39.8%）的 PMD 充分。PMD 充分与肠型肿瘤相关（67%比 45%，p=0.010）。估计的 5 年生存率分别为充分和不足 PMD 亚组的 63%（95%CI 51-78）和 62%（95%CI 53-73）。总体而言，多变量分析显示，PMD 充分与 OS 无相关性（HR 0.81，95%CI 0.48-1.38）。然而，在弥漫型肿瘤患者中，PMD 充分与改善的肿瘤学结果相关（中位 OS 未达到，而 131 个月时达到，p=0.038；中位 TTP 未达到，而 88.0 个月时达到，p=0.003）。
弥漫型胃癌患者更有可能因 PMD 不足而接受切除术，在这些患者中，PMD 不足与较差的肿瘤学结果相关。对于肠型肿瘤，PMD 与预后无相关性，这表明在无法达到广泛 PMD 的情况下，进行保留部分胃功能的远端胃切除术也是可行的。
