The importance of the proximal resection margin distance for proximal gastric adenocarcinoma: A multi-institutional study of the US Gastric Cancer Collaborative.
BACKGROUND
A 5 cm margin is advocated for distal gastric adenocarcinoma (GAC). The optimal proximal resection margin (PM) length for proximal GAC is not established.


METHODS
Patients who underwent curative-intent resection for proximal GAC from 2000 to 2012 at 7 centers in the US Gastric Cancer Collaborative were included. PM length was sequentially dichotomized and analyzed at 0.5 cm increments (0.5-6.5 cm). Outcomes after negative margin (R0) and positive microscopic margin (R1) resections were compared. Primary endpoints were local recurrence (LR) and overall survival (OS).


RESULTS
All patients (n = 162) had R0 distal margins. 151 (93.2%) had an R0-PM with mean length of 2.6 cm (median:1.7 cm; range:0.1-15 cm). A greater PM distance was not associated with LR or OS. An R1-PM was associated with higher N-stage (N3:73% vs. 26%; P = 0.007) and increased LR (HR6.1; P = 0.009) but not associated with decreased OS. On multivariate analysis, an R1-PM was also not independently associated with LR.


CONCLUSIONS
For resection of proximal gastric adenocarcinoma, proximal margin length is not associated with local recurrence or overall survival. An R1 margin is associated with advanced N-stage but is not independently associated with recurrence or survival. When performing resection of proximal gastric adenocarcinoma, efforts to achieve a specific margin distance, especially if it necessitates an esophagectomy, should be abandoned.
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Lauren M
LM
Postlewait
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Malcolm H
MH
Squires
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
David A
DA
Kooby
Department of Surgery, Stanford University Medical Center, Stanford, California.
George A
GA
Poultsides
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Sharon M
SM
Weber
Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
Mark
M
Bloomston
Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
Ryan C
RC
Fields
Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Timothy M
TM
Pawlik
Department of Surgery, Wake Forest University, Winston-Salem, North Carolina.
Konstantinos I
KI
Votanopoulos
Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
Carl R
CR
Schmidt
Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Aslam
A
Ejaz
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Alexandra W
AW
Acher
Department of Surgery, Stanford University Medical Center, Stanford, California.
David J
DJ
Worhunsky
Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
Neil
N
Saunders
Department of Surgery, Wake Forest University, Winston-Salem, North Carolina.
Douglas
D
Swords
Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
Linda X
LX
Jin
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Clifford S
CS
Cho
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Emily R
ER
Winslow
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Kenneth
K
Cardona
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Charles A
CA
Staley
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Shishir K
SK
Maithel
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control; D009367:Neoplasm Staging; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014481:United States
Siewert II and III; gastric cancer; proximal margin; recurrence; resection; survival