Prognostic value of the distance of proximal resection margin in patients who have undergone curative gastric cancer surgery

We conducted this retrospective study to analyze the relationship between the distance of the proximal resection margin (PRM) and the pattern of recurrence in patients with gastric cancer who underwent curative gastrectomy.

In our series, there were 774 patients who underwent curative gastrectomy for gastric adenocarcinoma. Thus, we classified our clinical series of patients into the distal gastrectomy group (n = 529) and the total gastrectomy group (n = 245). The clinical pathologic data and PRM distance were collected. Univariate and multivariate analyses were performed to evaluate association between PRM distance and locoregional recurrence.

The mean distance of the PRM was 4.03 cm in the total gastrectomy group. The distance of the PRM had a significant correlation with advanced T-stage, advanced N-stage,vascular invasion,lymphatic invasion, neural invasion, histological undifferentiation, greater tumor size, and the upper third of the tumor location. On multivariate analysis, tumor recurrence showed only the independent prognostic factor N-stage (P <0.023). The mean distance of the PRM was 6.4 cm in the distal gastrectomy group. The distance of the PRM had a significant correlation with the advanced T-stage, advanced N-stage, younger age, vascular invasion, histological undifferentiation, greater tumor size, and the middle third of tumor location. On multivariate analysis, tumor recurrence showed three independent prognostic factors, N-stage (P <0.001), vascular invasion (P = 0.009), and lower third tumor location (P = 0.035). The total gastrectomy of locoregional recurrence was related to N-stage (P = 0.039), and the distal gastrectomy of locoregional recurrence was related to T-stage (P = 0.021). Study on the disease-free survival, PRM distance, and locoregional recurrence was not statistically relevant in both the total and distal gastrectomy group (P = 0.565 and P = 0.584, respectively).

Our results indicate that a sufficient resection margin is not the absolute factor associated with the rate of survival and recurrence, although it is a key prognostic factor. The locoregional recurrence had no significant correlation with the distance of the PRM after curative gastrectomy.