Clinical impact of tumor infiltration at the transected surgical margin during gastric cancer surgery

Background When transected surgical margins are involved by tumor cells during gastrectomy for gastric cancer, dissemination of tumor cells to the peritoneal cavity may be a concern. Objectives The aim of this study is to evaluate the prognostic value of tumor infiltration at the transected surgical margin during gastrectomy. Methods A total of 1,717 patients with gastric cancer who underwent R0 gastrectomy were included. The relationship between positive margins on frozen biopsy during gastrectomy and clinicopathologic data was examined. The prognostic impact of this intraoperative event was evaluated by univariate and multivariate analysis. Results The intraoperative positive resection margin occurred in 69 patients (4.01%). Tumor size >5?cm, tumor located in the upper third or whole stomach, Bormann type IV gastric cancer, and signet ring cell histology were independent factors associated with that intraoperative event. pT and pN stages were significant prognostic factors associated with locoregional and/or peritoneal recurrence and overall recurrence. Tumor infiltration at the transected margin was not an independent prognostic factor associated with any recurrence. Conclusions Microscopic tumor involvement at the margin during gastric cancer surgery does not increase locoregional and/or peritoneal recurrence or overall recurrence independently if R0 resection is achieved by re-resection of the margin. J. Surg. Oncol. 2012; 106:772776. (c) 2012 Wiley Periodicals, Inc.