title: Surgical management of microscopic positive resection margin after gastrectomy for gastric cancer: a systematic review of gastric R1 management.
abstract: BACKGROUND
  The prognosis after a curative resection for gastric cancer is modified by the lymph node involvement, while the prognostic significance of a microscopically-positive resection margin is debated. We systematically reviewed the literature from 1998 to 2013 to describe the role of surgery in the management of gastric cancer with a R1 after gastrectomy.
  
  
  METHODS
  The research was systematically performed on Pubmed, EMbase, Cochrane Library, CILEA Archive, BMJ Clinical Evidence and Up ToDate databases. Twelve studies were included in this review, for a total of 15,008 patients.
  
  
  RESULTS
  The results reported in literature are inconsistent and the impact of surgical and oncological therapies is unknown. Intraoperative frozen sections should be performed to achieve a negative margin with intraoperative re-excision.
  
  
  CONCLUSIONS
  A surgical re-excision of an R1 resection should be considered for patients with fewer than three disease-positive nodes because survival is more likely to be governed by positive margins than by nodal status.
authors.affiliation: Department of General Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy paolo.aurello@uniroma1.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Aurello
authors.affiliation: Department of General Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Magistri
authors.affiliation: Department of General Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.affiliation: Department of General Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Petrucciani
authors.affiliation: Department of General Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Novi
authors.affiliation: Department of General Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Antolino
authors.affiliation: Department of General Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Angelo
authors.affiliation: Department of General Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
mesh_terms: D019468:Disease Management; D005743:Gastrectomy; D006801:Humans; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: Gastric cancer; R1; gastrectomy; microscopic residual disease; positive margins; resection line involvement