Related Experiment Video
Updated: Apr 18, 2026
Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma
Published on: August 9, 2016
Impact of Intraoperative Macroscopic Diagnosis of Serosal Invasion in Pathological Subserosal (pT3) Gastric Cancer
Dong Jin Kim1, Jun Hyun Lee2, Wook Kim1
1Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
Purpose:
The macroscopic diagnosis of tumor invasion through the serosa during surgery is not always distinct in patients with gastric cancer. The prognostic impact of the difference between macroscopic findings and pathological diagnosis of serosal invasion is not fully elucidated and needs to be re-evaluated.
Materials And Methods:
A total of 370 patients with locally advanced pT2 to pT4a gastric cancer who underwent curative surgery were enrolled in this study. Among them, 155 patients with pT3 were divided into three groups according to the intraoperative macroscopic diagnosis of serosal invasion, as follows: serosa exposure (SE)(-) (no invasion, 72 patients), SE(±) (ambiguous, 47 patients), and SE(+) (definite invasion, 36 patients), and the clinicopathological features, surgical outcomes, and disease-free survival (DFS) were analyzed.
Results:
A comparison of the 5-year DFS between pT3_SE(-) and pT2 groups and between pT3_SE(+) and pT4a groups revealed that the differences were not statistically significant. In addition, in a subgroup analysis of pT3 patients, the 5-year DFS was 75.1% in SE(-), 68.5% in SE(±), and 39.4% in SE(+) patients (P<0.05). In a multivariate analysis to evaluate risk factors for tumor recurrence, macroscopic diagnosis (hazard ratio [HR], SE(-) : SE(±) : SE(+)=1 : 1.01 : 2.45, P=0.019) and lymph node metastasis (HR, N0 : N1 : N2 : N3=1 : 1.45 : 2.20 : 9.82, P<0.001) were independent risk factors for recurrence.
Conclusions:
Gross inspection of serosal invasion by the surgeon had a strong impact on tumor recurrence in gastric cancer patients. Consequently, the gross appearance of serosal invasion should be considered as a factor for predicting patients' prognosis.
Insights
Surgeons' gross inspection of serosal invasion in gastric cancer impacts tumor recurrence. Macroscopic findings, especially definite invasion (SE+), are crucial for predicting patient prognosis and guiding treatment decisions.
Area of Science:
- Surgical Oncology
- Gastrointestinal Pathology
- Cancer Prognostics
Background:
- Macroscopic diagnosis of serosal invasion in gastric cancer can be indistinct during surgery.
- The prognostic significance of discrepancies between macroscopic and pathological serosal invasion assessments requires further evaluation.
Purpose of the Study:
- To re-evaluate the prognostic impact of macroscopic serosal invasion diagnosis in gastric cancer.
- To determine the relationship between intraoperative gross findings and disease-free survival (DFS).
Main Methods:
- Analysis of 370 locally advanced gastric cancer patients (pT2-pT4a) undergoing curative surgery.
- Stratification of 155 pT3 patients into serosa exposure (SE) groups: SE(-) (no invasion), SE(±) (ambiguous), and SE(+) (definite invasion).
- Comparison of clinicopathological features, surgical outcomes, and DFS across groups.
Main Results:
- Five-year DFS in pT3 patients: 75.1% for SE(-), 68.5% for SE(±), and 39.4% for SE(+) (P<0.05).
- Macroscopic diagnosis of serosal invasion was an independent risk factor for recurrence (HR for SE(+)=2.45).
- Lymph node metastasis was also a significant independent risk factor for recurrence.
Conclusions:
- Intraoperative macroscopic assessment of serosal invasion significantly influences gastric cancer recurrence.
- Gross appearance of serosal invasion should be incorporated into prognostic predictions for gastric cancer patients.
