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:
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.
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
Research background

The conventional guidelines suggest the surgeons to obtain an extensive resection margin during surgery for gastric cancer. Several recent studies have raised questions regarding the need for such extensive resection and necessity of total gastrectomy for tumors located on middle-third of stomach, while the consensus has not been reached. There are some studies those demonstrate the unnecessity of longer proximal resection margin (PRM) distance in early gastric cancer. However, there are very few regarding the PRM distance for advanced gastric cancer (AGC).

Research motivation

We would like to discover the optimal PRM distance for patients who undergo gastrectomy for AGC.

Research objectives

The objective of this study was to investigate the influence of the PRM distance on the oncologic outcomes of patients who underwent gastrectomy for AGC, thus to prove the safety of the PRM distance shorter than the conventional literatures suggest.

Research methods

We retrospectively collected data from 1518 patients who underwent total gastrectomy (TG) or distal gastrectomy (DG) for AGC between June 2004 and December 2007. The distances of the PRM and DRM were defined as the shortest distance from the most proximal or distal end to each resection line, measured on formalin-fixed surgical specimens by pathologists. The demographics and clinicopathologic outcomes were compared according to the different PRM categories and an analysis on the influence of PRM on recurrence-free survival and overall survival was performed.

Research results

The DG and TG groups showed no statistical difference in RFS or OS according to the distance of PRM. Multivariate analysis also revealed that in both groups, there was no significant difference in RFS or OS according to the PRM distance.

Research conclusions

The distance of PRM did not affect the incidence of recurrence or local recurrence. A greater PRM distance was not associated with better survival outcomes and a distance as short as < 1 cm did not correlate with worse OS or RFS. Therefore, the PRM distance shorter than conventional literatures suggest may be accepted.

Research perspectives

Further research would be essential to set a guideline for the optimal PRM distance for AGC. A long-term prospective study with detailed data on PRM including measurements done during operation by the surgeons and after fixation by the pathologists should give better answers.