title: Prognostic impact of resection margin involvement after extended (D2/D3) gastrectomy for advanced gastric cancer: a 15-year experience at a single institute.
abstract: OBJECTIVE
  The aim of this study was to investigate whether microscopic positive margins are detrimental to the outcome of gastric cancer patients treated with extended (D2/3) gastrectomy.
  
  
  METHODS
  Among 2,740 consecutive patients who had undergone extended gastrectomy for advanced gastric cancer between January 1987 and December 2002, 49 patients (1.8%) had positive resection margins on final histology.
  
  
  RESULTS
  Among 49 patients, 29 (59.2%) had proximal involved margins and 20 (40.8%) had distal involved margins. The median survival time of the positive margin group was 34 months. The negative margin group had a significantly longer median survival time of 69 months (P = 0.025). When both groups of patients were stratified according to nodal stage, a positive resection margin determined a worse prognosis only in patients with node-negative disease (174 months vs. 37 months, P = 0.0001). In patients with nodal metastasis, the median survival time was similar in both groups.
  
  
  CONCLUSIONS
  Our results suggest that a positive microscopic margin is associated with a worse outcome in patients with node-negative disease. Therefore, a more aggressive treatment, such as re-operation, is needed in node-negative patients with a positive microscopic disease.
authors.affiliation: Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Byoung Chul
authors.initials: BC
authors.lastname: Cho
authors.forename: Hei Cheul
authors.initials: HC
authors.lastname: Jeung
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Choi
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Rha
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Hyung
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Cheong
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
authors.forename: Hyun Cheol
authors.initials: HC
authors.lastname: Chung
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005743:Gastrectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate
chemical_list: D016685:Mitomycin; D004317:Doxorubicin; D002945:Cisplatin; D005472:Fluorouracil