Gall C A, Rieger N A, Wattchow D A
Department of Surgery, Flinders Medical Center, Bedford Park, Australia.
Aust N Z J Surg. 1996 Nov;66(11):734-7. doi: 10.1111/j.1445-2197.1996.tb00732.x.
Our aim was to determine the frequency, survival and symptomatic local recurrence rate of patients with a positive proximal resection margin in a series of patients having a resection for carcinoma of the oesophagus or stomach.
A retrospective study of pathology reports and case notes. Survival and data on local recurrence were obtained from the patient or general practitioner.
Ten (11.5%) of 87 patients having a gastric or oesophageal resection for carcinoma had a positive proximal resection margin. All 10 patients underwent a palliative resection for late-stage disease. Nine were dead at an average 8.3 months (range 2-20 months) post-resection and one patient remains alive at 9 months. Only one of these 10 patients had evidence of a local recurrence with recurrent dysphagia prior to death at 11 months.
A high incidence of a positive proximal resection margin was found. This occurred in patients who underwent a palliative resection for late-stage disease, most of whom died before local recurrence became a problem. For patients recognized as having late-stage disease, surgery for symptom palliation need not be aggressive (such as to include a thoracotomy) because achieving microscopic clearance is unlikely to affect the long-term outcome.
我们的目的是确定在一系列接受食管癌或胃癌切除术的患者中，近端切缘阳性患者的发生率、生存率及有症状的局部复发率。
对病理报告和病历进行回顾性研究。生存情况及局部复发数据来自患者或全科医生。
87例接受胃癌或食管癌切除术的患者中有10例（11.5%）近端切缘阳性。所有10例患者均因晚期疾病接受了姑息性切除。9例患者在切除术后平均8.3个月（范围2 - 20个月）死亡，1例患者在9个月时仍存活。这10例患者中只有1例在11个月死亡前有局部复发的证据，表现为复发性吞咽困难。
近端切缘阳性的发生率较高。这发生在因晚期疾病接受姑息性切除的患者中，其中大多数患者在局部复发成为问题之前就已死亡。对于被认定为晚期疾病的患者，缓解症状的手术不必过于激进（如开胸手术），因为实现微观切缘阴性不太可能影响长期预后。
