title: Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study.
abstract: BACKGROUND
  Resection margin (RM) involvement is associated with negative prognosis after gastrectomy. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is time-consuming and resource-consuming. The aim of this study was to assess risk factors associated with RM involvement to identify patients who would benefit from IFS analysis.
  
  
  METHODS
  We retrospectively analyzed patients who underwent gastrectomy with curative intent for gastric or esophagogastric junction (EGJ) cancer from 2000 to 2014 in six Italian hospitals. RM status was assessed by IFS analysis and/or definitive histopathology examination. A set of 21 potential risk factors were compared in a multivariate analysis between patients with positive RMs on IFS analysis or definitive histopathology examination and a control cohort of similar patients with negative RMs, with the samples stratified into three subgroups (T1, T2-T4 Lauren intestinal pattern, T2-T4 Lauren diffuse/mixed pattern).
  
  
  RESULTS
  One hundred forty-five patients had positive RMs. Survival was significantly worse in positive RM patients than in negative RM patients (89.5 months vs 28.9 months). Multivariate analysis showed that in T1 cancers a margin distance of less than 2 cm is a risk factor for RM involvement (odds ratio 15.7), in T2-T4 intestinal pattern cancers, serosa invasion (odds ratio 6.0), EGJ location (odds ratio 4.1), and a margin distance of less than 3 cm (odds ratio 4.0) are independent risk factors, and in T2-T4 diffuse/mixed pattern cancers, lymphatic infiltration (odds ratio 4.2), tumor diameter greater than 4 cm (odds ratio 3.5), EGJ location (odds ratio 2.8), and serosa invasion (odds ratio 2.2) are independent risk factors.
  
  
  CONCLUSIONS
  Survival after gastrectomy is negatively affected by positive RMs. IFS analysis should be routinely used in patients with a high risk of positive RMs, especially in diffuse pattern cancers.
authors.affiliation: Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. maxbisso@gmail.com.
authors.forename: Massimiliano
authors.identifier: http://orcid.org/0000-0002-2032-0138
authors.initials: M
authors.lastname: Bissolati
authors.affiliation: Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Desio
authors.affiliation: Digestive Surgery, A. Gemelli Hospital, Catholic University, Rome, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Rosa
authors.affiliation: Department of Surgical Sciences and Human Morphology, First Division of Surgery, Insubria University, Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rausei
authors.affiliation: Surgical Oncology Unit, University of Siena, Siena, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marrelli
authors.affiliation: Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy.
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Baiocchi
authors.affiliation: Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Manzoni
authors.affiliation: Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Chiari
authors.affiliation: Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guarneri
authors.affiliation: Digestive Surgery, A. Gemelli Hospital, Catholic University, Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pacelli
authors.affiliation: Surgical Oncology Unit, University of Siena, Siena, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: De Franco
authors.affiliation: Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Molfino
authors.affiliation: Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cipollari
authors.affiliation: Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Orsenigo
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D005163:Factor Analysis, Statistical; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000401:mortality*; D006801:Humans; D007558:Italy; D008297:Male; D000072662:Margins of Excision; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate
keywords: Esophagogastric junction; Gastrectomy; Gastric cancer; Intraoperative frozen section; Resection margins; Risk factors