Optimal proximal resection margin distance for gastrectomy in advanced gastric cancer
Amy Kim, Beom Su Kim, Jeong Hwan Yook, Byung Sik Kim
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: = 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.