Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2020; 26(18): 2232-2246
Published online May 14, 2020. doi: 10.3748/wjg.v26.i18.2232
Optimal proximal resection margin distance for gastrectomy in advanced gastric cancer
Amy Kim, Beom Su Kim, Jeong Hwan Yook, Byung Sik Kim
Amy Kim, Beom Su Kim, Jeong Hwan Yook, Byung Sik Kim, Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Amy Kim, Department of Surgery, Korea University Medical Center Ansan Hospital, Ansan, Gyeonggi-do 15355, South Korea
Author contributions: All authors equally contributed in designing the research; Kim A and Kim BS analyzed the data; Kim BS, Yook JH and Kim BS supervised the research; Kim A wrote and revised the manuscript.
Institutional review board statement: The study was approved by the Institutional Review Board of Asan Medical Center and the University of Ulsan College of Medicine, No. 2019-1036.
Informed consent statement: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent from patients for this retrospective study was waived by the institutional review board.
Conflict-of-interest statement: None of the authors have any conflict of interest or financial ties to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Beom Su Kim, MD, PhD, Surgeon, Associate professor, Division of Stomach Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, South Korea. bskim0251@naver.com
Received: March 8, 2020
Peer-review started: March 8, 2020
First decision: March 27, 2020
Revised: April 13, 2020
Accepted: April 29, 2020
Article in press: April 29, 2020
Published online: May 14, 2020
Processing time: 66 Days and 22.2 Hours
Abstract
BACKGROUND

The conventional guidelines to obtain a safe proximal resection margin (PRM) of 5-6 cm during advanced gastric cancer (AGC) surgery are still applied by many surgeons across the world. Several recent studies have raised questions regarding the need for such extensive resection, but without reaching consensus. This study was designed to prove that the PRM distance does not affect the prognosis of patients who undergo gastrectomy for AGC.

AIM

To investigate the influence of the PRM distance on the prognosis of patients who underwent gastrectomy for AGC.

METHODS

Electronic medical records of 1518 patients who underwent curative gastrectomy for AGC between June 2004 and December 2007 at Asan Medical Center, a tertiary care center in Korea, were reviewed retrospectively for the study. The demographics and clinicopathologic outcomes were compared between patients who underwent surgery with different PRM distances using one-way ANOVA and Fisher’s exact test for continuous and categorical variables, respectively. The influence of PRM on recurrence-free survival and overall survival were analyzed using Kaplan-Meier survival analysis and Cox proportional hazard analysis.

RESULTS

The median PRM distance was 4.8 cm and 3.5 cm in the distal gastrectomy (DG) and total gastrectomy (TG) groups, respectively. Patient cohorts in the DG and TG groups were subdivided into different groups according to the PRM distance; ≤ 1.0 cm, 1.1-3.0 cm, 3.1-5.0 cm and > 5.0 cm. The DG and TG groups showed no statistical difference in recurrence rate (23.5% vs 30.6% vs 24.0% vs 24.7%, P = 0.765) or local recurrence rate (5.9% vs 6.5% vs 8.4% vs 6.2%, P = 0.727) according to the distance of PRM. In both groups, Kalpan-Meier analysis showed no statistical difference in recurrence-free survival (P = 0.467 in DG group; P = 0.155 in TG group) or overall survival (P = 0.503 in DG group; P = 0.155 in TG group) according to the PRM distance. Multivariate analysis using Cox proportional hazard model revealed that in both groups, there was no significant difference in recurrence-free survival according to the PRM distance.

CONCLUSION

The distance of PRM is not a prognostic factor for patients who undergo curative gastrectomy for AGC.

Keywords: Stomach neoplasms; Gastrectomy; Margins of excision; Prognosis; Recurrence

Core tip: The conventional guidelines suggest the surgeons to obtain an extensive resection margin during surgery for gastric cancer. The objective of this study was to investigate the influence of the proximal resection margin (PRM) distance on the oncologic outcomes of advanced gastric cancer patients, thus to prove the safety of the PRM distance shorter than the conventional literatures suggest. The length of the PRM did not affect the prognosis of patients who underwent a curative gastrectomy for advanced gastric cancer.