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[R1 resection for gastric carcinoma].

K Ridwelski1,2, J Fahlke3, M Huß3

  • 1AN-Institut für Qualitätssicherung in der operativen Medizin an der Otto-von-Guericke-Universität Magdeburg gGmbH, Leipziger Str. 44, 39120, Magdeburg, Deutschland. Karsten.Ridwelski@Klinikum-Magdeburg.de.

Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|June 30, 2017
PubMed
Summary

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This summary is machine-generated.

R1 resection in gastric cancer worsens patient survival, particularly in early stages. Achieving R0 resection, often via frozen section or re-excision, is crucial for better outcomes.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Pathology

Background:

  • R1 resection, defined as microscopic tumor at the surgical margin, negatively impacts long-term survival in resected gastric carcinoma.
  • The prognostic significance of R1 resection varies with tumor stage and lymph node involvement.
  • While R0 resection (no tumor at the margin) is ideal, R1 situations present challenges in gastric cancer surgery.

Purpose of the Study:

  • To review the literature on R1 resection in gastric cancer.
  • To analyze factors influencing R1 rates and their impact on patient survival.
  • To discuss current strategies for achieving R0 resection and the role of re-excision.

Main Methods:

  • Literature review of studies reporting on R1 resection in gastric cancer.
Keywords:
Intraoperative frozen sectionLong-term survivalPrognosisReoperationRisk factors

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  • Analysis of factors associated with increased R1 rates, including tumor size, stage, and histology.
  • Evaluation of the impact of R1 status on survival and the effectiveness of re-excision.

    • Main Results:

    • R1 resection significantly worsens prognosis, especially in early T stages with limited lymph node metastasis.
    • R1 resection rates are around 5% for gastric cancer and over 10% for esophagogastric junction adenocarcinomas.
    • Tumor size (>5 cm), advanced T/N stages, poor differentiation, and specific histologies increase R1 risk.
    • Intraoperative frozen section is standard for R0 achievement; re-excision is recommended if R1 is found postoperatively, though rarely performed.

    Conclusions:

    • Achieving R0 resection is critical for improving gastric cancer patient survival.
    • While re-excision after R1 detection can improve outcomes, it is infrequently utilized.
    • Further evidence is needed regarding the role of adjuvant therapies in R1 resection cases.