Impact of proximal resection margin involvement on survival outcome in patients with proximal gastric cancer

2019 ◽  
Vol 73 (8) ◽  
pp. 470-475
Author(s):  
Bochao Zhao ◽  
Huiwen Lu ◽  
Shiyang Bao ◽  
Rui Luo ◽  
Di Mei ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymphovascular Invasion ◽  
Resection Margin ◽  
Survival Outcome ◽  
Resection Margins ◽  
Serosal Invasion ◽  
Proximal Gastric Cancer ◽  
Margin Involvement ◽  
Positive Resection Margins ◽  
Proximal Resection Margin

AimThe aim of this study was to evaluate the risk factors for proximal resection margin involvement and its impact on survival outcome in patients with proximal gastric cancer.MethodsA total of 488 patients who underwent potentially curative resection for proximal gastric cancer were retrospectively reviewed. Clinicopathological characteristics and survival differences between patients with positive and negative resection margins were compared and prognostic factors were determined by Cox multivariate analysis.ResultsIn this study, 7.6% (37/488) of patients with proximal gastric cancer had a positive proximal resection margin after postoperative histopathological examination. Positive resection margins were significantly associated with advanced tumour stage and more aggressive biological features including larger tumour size, serosal invasion and lymphovascular invasion. Serosal invasion (OR 4.543, 95% CI 2.201 to 9.380, p<0.001) and lymphovascular invasion (OR 2.279, 95% CI 1.129 to 4.600, p<0.05) were independent risk factors for positive proximal resection margins. In terms of survival outcome, positive resection margins had an adverse impact on the prognosis of patients with proximal gastric cancer (median DFS: 20.7 vs 30.2 months, p<0.001). The multivariate analysis indicated that positive resection margins (HR 1.494, 95% CI 1.042 to 2.142, p=0.029), T stage (T3–T4, HR 2.264, 95% CI 1.484 to 3.454, p<0.001) and N stage (N1–N2 stage, HR 1.696, 95% CI 1.279 to 2.248, p<0.001; N3 stage, HR 2.691, 95% CI 1.967 to 3.681, p<0.001) were independent prognostic factors for patients with proximal gastric cancer.ConclusionProximal resection margin involvement was an indicator of more aggressive tumours and an independent prognostic factor for patients with proximal gastric cancer. Aggressive efforts should be made to achieve a negative resection margin if gastric cancer was deemed to be potentially resectable.

Clinical outcomes of positive resection margins after endoscopic resection of early colorectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 688-688
Author(s):  
Jin-Oh Kim
Keyword(s):  
Cancer Cells ◽  
Clinical Outcomes ◽  
Cancer Cell ◽  
Endoscopic Resection ◽  
Resection Margin ◽  
Early Colorectal Cancer ◽  
Resection Margins ◽  
Positive Resection Margin ◽  
Positive Group ◽  
Positive Resection Margins

688 Background: The management of patients with a positive resection margin after endoscopic resection of early colorectal cancer (ECC) depends on various clinical factors, including the pathology. There is little information on the clinical outcomes according to the subsequent management of a positive resection margin in patients with ECC treated by endoscopic resection. We assessed the management according to the pathology of the positive margin and evaluated the clinical outcomes. Methods: Consecutive patients with ECC who underwent endoscopic resection from January 2004 to December 2014 were reviewed. This study retrospectively analyzed 363 lesions from 338 patients (mean age, 60.1 years; 68% [230/338] male). Results: The resection margin was positive in 29.2% of patients, including cancer cells in 9.9%, adenoma in 16.5%, and high-grade dysplasia (HGD) in 2.8%. Subsequent surgery was performed on 11.8% of patients, 72.2% (26/43) of whom were cancer cell–positive, while 23.3% (10/43) were resection margin–negative but had deep submucosal (SM) or lymphatic invasion. Remnant cancer cells were identified in 25.6% (11/43) of the operated group and 81.8% (9/11) of the cancer cell–positive group. On early follow-up surveillance colonoscopy (mean interval, 3.57 months) in 88.2% of patients (320/363), including 95.7% (67/70) of the adenoma and HGD-positive group, only one (0.3%, 1/320) case of remnant adenoma was found. In the multivariate analysis, deep SM invasion ( p=0.026), number of pieces of piecemeal resection (p=0.03) and cancer cell positivity ( p=0.001) predicted subsequent surgery. In the multivariate analysis, an endoscopic appearance of incomplete resection ( p=0.002) and cancer cell positivity (p=0.041) were related to the identification of remnant cancer cells after subsequent surgery. Conclusions: Patients with an adenoma-positive resection margin had favorable clinical outcomes during subsequent surveillance. The choice of subsequent surgery was related to deep SM invasion and cancer cell–positive resection margins, and subsequent surgery group showed a high rate of remnant cancer cells.

scholarly journals Examination of the Resection Margin Involvement after Gastrectomy for Gastric Cancer

2013 ◽  
Vol 46 (5) ◽  
pp. 317-324 ◽  
Author(s):  
Takanori Konishi ◽  
Nobuhiro Takiguchi ◽  
Hiroaki Soda ◽  
Matsuo Nagata ◽  
Yoshihiro Nabeya ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Resection Margin ◽  
Margin Involvement

scholarly journals The Impact of Preoperative Breast MRI on Surgical Margin Status in Breast Cancer Patients Recalled at Biennial Screening Mammography: An Observational Cohort Study

2021 ◽  
Author(s):  
Jessie J. J. Gommers ◽  
Lucien E. M. Duijm ◽  
Peter Bult ◽  
Luc J. A. Strobbe ◽  
Toon P. Kuipers ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Surgical Margin ◽  
Screening Mammography ◽  
Resection Margins ◽  
Regression Analyses ◽  
Breast Cancer Patients ◽  
Margin Involvement ◽  
Multivariable Regression ◽  
Positive Resection Margins

Abstract Background This study aimed to examine the association between preoperative magnetic resonance imaging (MRI) and surgical margin involvement, as well as to determine the factors associated with positive resection margins in screen-detected breast cancer patients undergoing breast-conserving surgery (BCS). Methods Breast cancer patients eligible for BCS and diagnosed after biennial screening mammography in the south of The Netherlands (2008–2017) were retrospectively included. Missing values were imputed and multivariable regression analyses were performed to analyze whether preoperative MRI was related to margin involvement after BCS, as well as to examine what factors were associated with positive resection margins, defined as more than focally (>4 mm) involved. Results Overall, 2483 patients with invasive breast cancer were enrolled, of whom 123 (5.0%) had more than focally involved resection margins. In multivariable regression analyses, preoperative MRI was associated with a reduced risk of positive resection margins after BCS (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.33–0.96). Lobular histology (adjusted OR 2.86, 95% CI 1.68–4.87), large tumor size (per millimeter increase, adjusted OR 1.05, 95% CI 1.03–1.07), high (>75%) mammographic density (adjusted OR 3.61, 95% CI 1.07–12.12), and the presence of microcalcifications (adjusted OR 4.45, 95% CI 2.69–7.37) and architectural distortions (adjusted OR 1.85, 95% CI 1.01–3.40) were independently associated with positive resection margins after BCS. Conclusions Preoperative MRI was associated with lower risk of positive resection margins in patients with invasive breast cancer eligible for BCS using multivariable analysis. Furthermore, specific mammographic characteristics and tumor characteristics were independently associated with positive resection margins after BCS.

Radiotherapy for intrahepatic cholangiocarcinoma: An analysis of the National Cancer Database.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 379-379
Author(s):  
Abdulrahman Y Hammad ◽  
George Younan ◽  
Rahul Rajeev ◽  
Nicholas Gerard Berger ◽  
Kiran Turaga ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Resection Margin ◽  
Early Stage ◽  
Disease Stage ◽  
Resection Margins ◽  
National Cancer Database ◽  
Kaplan Meier ◽  
Positive Resection Margins ◽  
The Impact

379 Background: The role of radiotherapy (RT) for surgically resected intrahepatic cholangiocarcinoma (ICC) remains poorly defined. Radiotherapy is often considered when a positive resection margin exists. The present study sought to examine the impact of radiotherapy following liver resection. Methods: Patients with early stage ICC, who underwent surgical resection, were identified from the National Cancer Database (1998-2011). Patients were stratified by resection margin status and receipt of RT. Survival was analyzed by Kaplan-Meier method and a multivariate regression model was used to identify predictors of survival. Results: A total of 2,182 patients were identified. R0 status was obtained in 1,624 patients (74.4%). RT was delivered to 405 patients (R0=209, R1/R2=196). In the R1/R2 group, 196 patients received RT vs. 362 R1/R2 patients that did not receive RT. Survival for R0 vs. R1/R2 was 32m vs. 16.5m (p<0.001). RT appeared to trend toward improving survival for R1/R2 patients, though this was not significant (20.4m vs. 14.5m, p=0.191). In a multivariate model accounting for age, sex, comorbidities, disease stage and resection margins, RT was not a predictor of survival. Negative predictors of survival included age>65years (Hazards Ratio [HR]: 1.20 (95%CI: 1.04-1.39), p=0.013), and positive resection margins (HR: 1.95 (95%CI: 1.65-2.30), p<0.001). Female sex was the only positive predictor of survival identified (HR: 0.76 (95%CI: 0.65 -0.88), p<0.001). Conclusions: Surgical resection with negative margins provides the best outcome for patients with ICC. Radiotherapy does not appear to significantly impact survival in patients with positive resection margins.

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