title: Resection line involvement after gastric cancer surgery: clinical outcome in nonsurgically retreated patients.
abstract: OBJECTIVE
  Resection line infiltration (RLI) after surgical treatment represents an unfavorable prognostic factor in advanced gastric cancer. We performed a retrospective analysis of 89 patients with resection line involvement who did not undergo reoperation.
  
  
  METHODS
  On behalf of the Italian Research Group for Gastric Cancer, we present the characteristics and outcome of 89 patients who were submitted to surgical resection for gastric cancer from 1988 to 2001 and did not undergo reoperation because of disease extension or associated pathologies.
  
  
  RESULTS
  RLI was significantly higher in patients with T4 tumors and diffuse histological type. Anastomotic leakages were observed in 4.8% of infiltrated esophageal resection margins, whereas 1.9% of infiltrated duodenal resection lines showed duodenal fistulas. Five-year overall survival of patients with RLI was 29%. Prognosis was not affected by RLI in early forms (100% 5-year survival); however, 5-year survival in T2 and T3 stages was significantly lower with respect to the same stages without residual tumor. The influence of RLI on prognosis was confirmed in N0 as well as in N1 and N2 patients. RLI also was an independent prognostic at multivariate analysis (odds ratio = 1.5; 95% confidence interval, 1.08-2.08; P = 0.0144).
  
  
  CONCLUSIONS
  RLI significantly affects long-term survival of advanced gastric cancer. The impact on prognosis is independent of lymph node involvement. Patients in good general condition for whom radical surgery is possible should be considered for reoperation.
authors.affiliation: Department of General Surgery, Morgagni-Pierantoni Hospital, Via Forlanini 34, 47100, Forlì, Italy. p.morgagni@ausl.fo.it
authors.forename: P
authors.initials: P
authors.lastname: Morgagni
authors.forename: D
authors.initials: D
authors.lastname: Garcea
authors.forename: D
authors.initials: D
authors.lastname: Marrelli
authors.forename: G
authors.initials: G
authors.lastname: De Manzoni
authors.forename: G
authors.initials: G
authors.lastname: Natalini
authors.forename: H
authors.initials: H
authors.lastname: Kurihara
authors.forename: A
authors.initials: A
authors.lastname: Marchet
authors.forename: L
authors.initials: L
authors.lastname: Saragoni
authors.forename: E
authors.initials: E
authors.lastname: Scarpi
authors.forename: C
authors.initials: C
authors.lastname: Pedrazzani
authors.forename: A
authors.initials: A
authors.lastname: Di Leo
authors.forename: F
authors.initials: F
authors.lastname: De Santis
authors.forename: V
authors.initials: V
authors.lastname: Panizzo
authors.forename: D
authors.initials: D
authors.lastname: Nitti
authors.forename: F
authors.initials: F
authors.lastname: Roviello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005743:Gastrectomy; D006801:Humans; D007558:Italy; D008197:Lymph Node Excision; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual; D012086:Reoperation; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult