Systematic review of the predictors of positive margins in gastric cancer surgery and the effect on survival

Raziee, H. R. and Cardoso, R. and Seevaratnam, R. and Mahar, A. and Helyer, L. and Law, C. and Coburn, N. (2012) Systematic review of the predictors of positive margins in gastric cancer surgery and the effect on survival. Gastric Cancer, 15 (SUPPL.). S116-S124.

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Background: Complete resection is the only definitive treatment available for gastric cancer. Factors associated with positive margins and their survival effects have been the subject of many studies, but the appropriate management for these patients is still debated. The objective of this review is to examine positive margins after gastric cancer resections by exploring predictive factors, impact on survival, and optimal strategies for re-resection. Methods: A systematic electronic literature search was conducted using Medline and EMBASE from January 1, 1998, to December 31, 2009. Studies on gastric or gastroesophageal junction adenocarcinoma that either investigated the predictors for positive margin or employed multivariate methods to analyze the survival effects of positive margins were selected. Results: Twenty-two studies incorporating 19355 patients were included in this review. Positive margins were associated with larger tumor size, deeper wall penetration, more extensive gastric involvement, greater nodal involvement, higher stage, diffuse histology, higher Borrmann type, lymphatic vessel involvement, and total gastrectomy. Patient survival was independently associated with margin status, and this survival effect was more prominent in early cancers in most studies that performed subgroup analyses. Conclusions: The probability of acquiring positive margins is highly dependent on the biology and the extent of the tumor. There is a significant negative effect on survival, which is more prominent in cancers at early stages, making re-resection or a second operation important. Patients with more advanced disease can be offered more extensive surgery to remove disease, but this should be balanced against the risks of more extensive resections. © 2011 The International Gastric Cancer Association and The Japanese Gastric Cancer Association.

Item Type: Article
Additional Information: Cited By :44 Export Date: 16 February 2020 CODEN: GCANF Correspondence Address: Coburn, N.; Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada; email:
Uncontrolled Keywords: Gastrectomy Positive margins Prognosis Stomach neoplasms Surgery Survival rate cancer classification cancer prognosis cancer survival disease severity histopathology human lymph node metastasis lymph vessel oncological parameters positive margin priority journal review risk factor stomach cancer systematic review total stomach resection tumor invasion tumor volume adenocarcinoma cancer staging esophagus tumor lower esophagus sphincter methodology pathology predictive value stomach tumor survival treatment outcome Esophageal Neoplasms Esophagogastric Junction Humans Lymphatic Metastasis Neoplasm Staging Predictive Value of Tests Survival Analysis
Subjects: WI Digestive System
WO Surgery
Divisions: Mashhad University of Medical Sciences
Depositing User: mr lib5 lib5
Date Deposited: 21 Apr 2020 05:54
Last Modified: 21 Apr 2020 05:54

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