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Minimum resection length to ensure a pathologically negative distal margin and a larger remnant stomach for esophagogastric junction cancer

  • 0Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Gastric Cancer : Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association +

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January 17, 2025

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January 17, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Determining the optimal distal margin (DM) length is crucial for esophagogastric junction (EGJ) cancer surgery. This study establishes specific DM recommendations based on tumor growth and pathological types to ensure negative margins and preserve stomach volume.

Area Of Science

  • Surgical Oncology
  • Gastroenterology
  • Pathology

Background

  • Achieving a pathologically negative distal margin (DM) is vital in proximal gastrectomy (PG) for esophagogastric junction (EGJ) cancer.
  • Preserving a larger remnant stomach is also a key surgical goal, but the minimum required DM length for negative margins remains undefined.

Purpose Of The Study

  • To determine the minimum distal margin (DM) length required to ensure pathologically negative margins in patients undergoing proximal gastrectomy (PG) or total gastrectomy for esophagogastric junction (EGJ) cancer.
  • To establish evidence-based recommendations for DM length based on tumor characteristics to optimize surgical outcomes.

Main Methods

  • Evaluated a cohort of 253 patients undergoing PG or total gastrectomy for EGJ cancer.
  • Assessed the pathological extension distally beyond the gross tumor boundary (ΔDM) to determine the maximum ΔDM, representing the minimum length for a negative margin.
  • Conducted subgroup analyses based on tumor growth and pathological types, and calculated the potential incidence of positive DMs with reduced gross margin lengths.

Main Results

  • The maximum ΔDM observed across all patients was 55 mm.
  • Tumor growth and pathological types significantly influenced ΔDM. Maximum ΔDM varied: 30/20/55 mm for superficial/expansive/infiltrative types and 55/40 mm for differentiated/undifferentiated types, respectively.
  • Even with a reduced gross DM of 30 mm, the incidence of pathologically positive DMs remained low (2.6%) in the infiltrative differentiated type.

Conclusions

  • Recommended minimum distal margin (DM) lengths are 30 mm for superficial, 20 mm for expansive, and 55 mm for infiltrative growth types.
  • For the infiltrative growth type, specific recommendations are 30 mm for differentiated and 40 mm for undifferentiated types, with mandatory intraoperative frozen section analysis.
  • These findings provide crucial guidance for optimizing surgical resection in EGJ cancer, balancing oncological safety with organ preservation.

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