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. 1982 Dec;196(6):685–690. doi: 10.1097/00000658-198212001-00012

Adequacy of margins of resection in gastrectomy for cancer.

F Bozzetti, G Bonfanti, R Bufalino, V Menotti, S Persano, S Andreola, R Doci, L Gennari
PMCID: PMC1352985  PMID: 7149820

Abstract

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.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Buchholtz T. W., Welch C. E., Malt R. A. Clinical correlates of resectability and survival in gastric carcinoma. Ann Surg. 1978 Dec;188(6):711–715. doi: 10.1097/00000658-197812000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. EKER R. Carcinomas of the stomach; investigation of the lymphatic spread from gastric carcinomas after total and partial gastrectomy. Acta Chir Scand. 1951;101(2):112–126. [PubMed] [Google Scholar]
  3. Goldsmith H. S., Akiyama H. A comparative study of Japanese and American gastric dimensions. Ann Surg. 1979 Dec;190(6):690–693. doi: 10.1097/00000658-197912000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Iwanaga T., Koyama H., Furukawa H., Taniguchi H., Wada A., Tateishi R. Mechanisms of late recurrence after radical surgery for gastric carcinoma. Am J Surg. 1978 May;135(5):637–640. doi: 10.1016/0002-9610(78)90126-5. [DOI] [PubMed] [Google Scholar]
  5. Keighley M. R., Moore J., Lee J. R., Malins D., Thompson H. Peroperative frozen section and cytology to assess proximal invasion in gastro-oesophageal carcinoma. Br J Surg. 1981 Feb;68(2):73–74. doi: 10.1002/bjs.1800680203. [DOI] [PubMed] [Google Scholar]
  6. Kodama Y., Sugimachi K., Soejima K., Matsusaka T., Inokuchi K. Evaluation of extensive lymph node dissection for carcinoma of the stomach. World J Surg. 1981 Mar;5(2):241–248. doi: 10.1007/BF01658301. [DOI] [PubMed] [Google Scholar]
  7. Koga S., Kishimoto H., Tanaka K., Kawaguchi H. Clinical and pathologic evaluation of patients with recurrence of gastric cancer more than five years postoperatively. Am J Surg. 1978 Sep;136(3):317–321. doi: 10.1016/0002-9610(78)90284-2. [DOI] [PubMed] [Google Scholar]
  8. Mine M., Majima S., Harada M., Etani S. End results of gastrectomy for gastric cancer: effect of extensive lymph node dissection. Surgery. 1970 Nov;68(5):753–758. [PubMed] [Google Scholar]
  9. Papachristou D. N., Agnanti N., D'Agostino H., Fortner J. G. Histologically positive esophageal margin in the surgical treatment of gastric cancer. Am J Surg. 1980 May;139(5):711–713. doi: 10.1016/0002-9610(80)90369-4. [DOI] [PubMed] [Google Scholar]
  10. Papachristou D. N., Fortner J. G. Local recurrence of gastric adenocarcinomas after gastrectomy. J Surg Oncol. 1981;18(1):47–53. doi: 10.1002/jso.2930180108. [DOI] [PubMed] [Google Scholar]
  11. Parisi V., Picone A., Mastro A. A., Cerra R. Correlazione clinico-statistica su 286 casi di carcinoma dello stomaco di tipo intestinale e diffuso. Tumori. 1976 Jan-Feb;62(1):25–38. doi: 10.1177/030089167606200104. [DOI] [PubMed] [Google Scholar]
  12. Paulino F., Roselli A. Carcinoma of the stomach. With special reference to total gastrectomy. Curr Probl Surg. 1973 Nov;:3–72. [PubMed] [Google Scholar]
  13. SUNDERLAND D. A., McNEER G., ORTEGA L. G., PEARCE L. S. The lymphatic spread of gastric cancer. Cancer. 1953 Sep;6(5):987–996. doi: 10.1002/1097-0142(195309)6:5<987::aid-cncr2820060518>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  14. Schrock T. R., Way L. W. Total gastrectomy. Am J Surg. 1978 Mar;135(3):348–355. doi: 10.1016/0002-9610(78)90064-8. [DOI] [PubMed] [Google Scholar]
  15. Serlin O., Keehn R. J., Higgins G. A., Jr, Harrower H. W., Mendeloff G. L. Factors related to survival following resection for gastric carcinoma: analysis of 903 cases. Cancer. 1977 Sep;40(3):1318–1329. doi: 10.1002/1097-0142(197709)40:3<1318::aid-cncr2820400349>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  16. Shiu M. H., Papacristou D. N., Kosloff C., Eliopoulos G. Selection of operative procedure for adenocarcinoma of the midstomach. Twenty years' experience with implications for future treatment strategy. Ann Surg. 1980 Dec;192(6):730–737. doi: 10.1097/00000658-198012000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. White R. R., Mackie J. A., Fitts W. T., Jr An analysis of twenty years' experience with operations for carcinoma of the stomach. Ann Surg. 1975 May;181(5):611–615. doi: 10.1097/00000658-197505000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Yamada E., Miyaishi S., Nakazato H., Kato K., Kito T., Takagi H., Yasue M., Kato T., Morimoto T., Yamauchi M. The surgical treatment of cancer of the stomach. Int Surg. 1980 Sep-Oct;65(5):387–399. [PubMed] [Google Scholar]
  19. ZINNINGER M. M. Extension of gastric cancer in the intramural lymphatics and its relation to gastrectomy. Am Surg. 1954 Sep;20(9):920–927. [PubMed] [Google Scholar]
  20. Zinninger M. M., Collins W. T. Extension of Carcinoma of the Stomach into the Duodenum and Esophagus. Ann Surg. 1949 Sep;130(3):557–566. doi: 10.1097/00000658-194909000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]

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