Bozzetti F, Bonfanti G, Bufalino R, Menotti V, Persano S, Andreola S, Doci R, Gennari L
Ann Surg. 1982 Dec;196(6):685-90. doi: 10.1097/00000658-198212001-00012.
This study determines the infiltration rate of proximal and distal margins of resection in patients operated on for gastric cancer at the Istituto Nazionale Tumori of Milan. Two hundred and eighty-five proximal margins and 286 distal margins were reviewed, and the incidence of infiltration was related to the length of grossly tumor-free edge, the location, site, size and gross appearance of the tumor, degree of invasion of the gastric wall, histologic type, and status of perigastric lymph nodes. Infiltration occurred in 7.3% of oral margins of transection and in 2.6% of aboral margins. Except for the degree of invasion of the gastric wall, no correlation was found among the infiltration rate and the above parameters. In fact, the incidence of infiltration of the proximal edge was significantly higher (6.4+ vs. 0.8%, p less than 0.01) when the tumor penetrated the serosa or spread beyond it than when the lesion was confined to the mucosa, submucosa, or muscular layer. With reference to the length of margin of resection, it is noteworthy that no involvement was found when cranial distance between the lesion and line of transection was equal to or greater than 6 cm. Proximal or distal infiltration for a distance greater than 3 cm did not occur in patients with lesions confined to the mucosa, submucosa, and muscularis. This data should provide the surgeon with a rational basis for assessing the extent of resection when performing gastrectomy for cancer.
本研究确定了在米兰国立肿瘤研究所接受胃癌手术患者的切除近端和远端切缘的浸润率。对285个近端切缘和286个远端切缘进行了评估，浸润发生率与大体无肿瘤边缘的长度、肿瘤的位置、部位、大小和大体外观、胃壁浸润程度、组织学类型以及胃周淋巴结状态相关。在横断的口侧切缘中浸润发生率为7.3%，在远侧切缘中为2.6%。除胃壁浸润程度外，未发现浸润率与上述参数之间存在相关性。实际上，当肿瘤穿透浆膜或超出浆膜时，近端切缘的浸润发生率显著更高（6.4%对0.8%，p<0.01），而当病变局限于黏膜、黏膜下层或肌层时则不然。关于切除边缘的长度，值得注意的是，当病变与横断线之间的头侧距离等于或大于6 cm时，未发现有浸润。病变局限于黏膜层、黏膜下层和肌层的患者未出现大于3 cm的近端或远端浸润。这些数据应为外科医生在进行胃癌胃切除术时评估切除范围提供合理依据。
