title: Outcome of failure in clearing the oesophageal margin in total gastrectomy for adenocarcinoma.
abstract: Failure to clear the oesophageal margin in total gastrectomy for adenocarcinoma is believed to be a major cause of mortality and morbidity. The incidence of histologically positive margin could range from 7.3 to 74%. Forty nine cases of total gastrectomy for adenocarcinoma were reviewed and nine (18%) had a positive oesophageal margin. One of the nine patients died on the second postoperative day from technical difficulty: the rest did not have anastomotic leaks. They all eventually died of metastatic disease in 3-20 months. Two had mild dysphagic symptoms which did not require active intervention. It is concluded that a histologically positive oesophageal margin in total gastrectomy does not preclude good anastomotic healing. Sound surgical judgement is required to balance the risk of leaving a positive margin and the risk of an extended operative procedure particularly when majority of the total gastrectomies are palliative rather than curative.
authors.affiliation: Department of Surgery, National University Hospital, Singapore.
authors.forename: H S
authors.initials: HS
authors.lastname: Goh
authors.forename: T H
authors.initials: TH
authors.lastname: Wong
authors.forename: T K
authors.initials: TK
authors.lastname: Ti
authors.forename: A
authors.initials: A
authors.lastname: Rauff
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*