[Importance of tumor growth and spread for surgical radical excision]

Different organ tumours of the gastrointestinal tract show variations in invasion patterns which are partly dependent on the biological characteristics of the tumour and partly dependent on the anatomical situation of the involved organ. It is important for the surgeon to have knowledge of the local invasion behaviours in making a precise indication for surgery, in the planning and in the technical accomplishment of the operation. Residual tumour has been shown to be a particular important prognostic factor. This paper investigates a large series of patients with different organ tumours in order to find in which location a R1 situation must be expected and which surgical consequences should be thus derived. The percentage of R0 resections in all patients who underwent resection differed in the individually examined organs: oesophagus, 65%; stomach, 80%; pancreas, 77%; colon, 81%; rectum, 84%. R1 resections also showed differences in incidence: oesophagus, 17%; stomach, 7%; pancreas, 13%; colon, 3%; rectum, 4%. Residual tumour was most frequently found in the lateral (superficial or free) resection margins: oesophagus, 79%; stomach, 67%; pancreas, 86%; colon, 78%; rectum, 74%. The other resection margins were significantly less-frequently involved.