Is It Time to Abandon the 5-cm Margin Rule During Resection of Distal Gastric Adenocarcinoma? A Multi-Institution Study of the U.S. Gastric Cancer Collaborative
Background A proximal margin distance of 5 cm is advocated for resection of gastric adenocarcinoma (GAC). We assessed the prognostic value of proximal margin (PM) distance on survival outcomes after resection of distal GAC. Methods All patients who underwent resection of distal GAC (antrum/body) fro...
Gespeichert in:
| Veröffentlicht in: | Annals of surgical oncology 2015-04, Vol.22 (4), p.1243-1251 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1251 |
|---|---|
| container_issue | 4 |
| container_start_page | 1243 |
| container_title | Annals of surgical oncology |
| container_volume | 22 |
| creator | Squires III, Malcolm H. Kooby, David A. Poultsides, George A. Pawlik, Timothy M. Weber, Sharon M. Schmidt, Carl R. Votanopoulos, Konstantinos I. Fields, Ryan C. Ejaz, Aslam Acher, Alexandra W. Worhunsky, David J. Saunders, Neil Levine, Edward A. Jin, Linda X. Cho, Clifford S. Bloomston, Mark Winslow, Emily R. Russell, Maria C. Cardona, Ken Staley, Charles A. Maithel, Shishir K. |
| description | Background
A proximal margin distance of 5 cm is advocated for resection of gastric adenocarcinoma (GAC). We assessed the prognostic value of proximal margin (PM) distance on survival outcomes after resection of distal GAC.
Methods
All patients who underwent resection of distal GAC (antrum/body) from 2000 to 2012 at seven institutions of the U.S. Gastric Cancer Collaborative were included. Patients with positive distal margins or macroscopic residual disease were excluded. The prognostic value of PM distance (assessed in 0.5-cm increments) on overall (OS) and recurrence-free survival (RFS) was assessed by Kaplan–Meier and multivariate regression analysis.
Results
A total of 465 patients underwent resection of distal GAC. Of these, 435 had R0 resections; 30 patients had a positive PM. 143 patients had stage I, and 322 had stage II–III tumors. Median follow-up was 44 months. Average PM distance was 4.8 cm. Median OS for patients with PM of 3.1–5.0 cm (
n
= 110) was superior to patients with PM ≤ 3.0 cm (
n
= 176) (48.1 vs. 29.3 months;
p
= 0.01), while a margin >5.0 cm (
n
= 179) offered equivalent survival to PM 3.1–5.0 cm (50.6 months,
p
= 0.72). The prognostic value of margin distance was stage specific. On multivariate analysis of stage I patients, PM 3.1–5.0 cm remained associated with improved OS [hazard ratio (HR), 0.16; 95 % confidence interval (95 % CI), 0.04–0.60;
p
= 0.01]. In stage II–III, neither PM 3.1–5.0 cm nor PM > 5.0 cm was significantly associated with OS; OS was dictated by T stage and nodal involvement.
Conclusions
The prognostic value of proximal margin distance after resection of distal gastric cancer appears stage specific. In stage I, a 3.1- to 5.0-cm proximal margin is associated with the same improved OS as a > 5.0-cm margin. In stage II–III disease, other adverse pathologic factors more strongly impact survival than proximal margin distance. |
| doi_str_mv | 10.1245/s10434-014-4138-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1660417106</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1660417106</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-d83f92904182ab22320aea064c32e2815166518aa7ac51306b49f916bf4163c63</originalsourceid><addsrcrecordid>eNp1kdtqFTEUhoMo9qAP4I0EvPFmtlk5zcyVbHZt3dAi9HA9ZDKZmjKTbHMotE_jo5px1yKCVwnh-_-1yIfQOyAroFx8ikA44xUBXnFgTfX4Ah2CKC9cNvCy3IlsqpZKcYCOYrwjBGpGxGt0QAUDyVs4RD-3EW8Tvrazwcnjda_c4B1O3w0WlZ7xhQq31uHLPBl8koN1t_jSRKOTLZQf8YmNSU34TMUUrMbrwTivVdDW-Vl9xmt8kadkq62Lyab8O3WV8vCwZJchN6ur1XN6o5w2AW_8NKneB5XsvXmDXo1qiubt03mMbk6_XG--Vuffzrab9XmlWU1TNTRsbGlLODRU9ZQySpRRRHLNqKENCJBSQKNUrbQARmTP27EF2Y8cJNOSHaOP-95d8D-yiambbdSmbOKMz7Er-VJely8t6Id_0DufgyvbFUo0LdSiEYWCPaWDjzGYsdsFO6vw0AHpFn3dXl9X9HWLvu6xZN4_Ned-NsNz4o-vAtA9EHeLCxP-Gv3f1l8fW6QC</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1658917585</pqid></control><display><type>article</type><title>Is It Time to Abandon the 5-cm Margin Rule During Resection of Distal Gastric Adenocarcinoma? A Multi-Institution Study of the U.S. Gastric Cancer Collaborative</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Squires III, Malcolm H. ; Kooby, David A. ; Poultsides, George A. ; Pawlik, Timothy M. ; Weber, Sharon M. ; Schmidt, Carl R. ; Votanopoulos, Konstantinos I. ; Fields, Ryan C. ; Ejaz, Aslam ; Acher, Alexandra W. ; Worhunsky, David J. ; Saunders, Neil ; Levine, Edward A. ; Jin, Linda X. ; Cho, Clifford S. ; Bloomston, Mark ; Winslow, Emily R. ; Russell, Maria C. ; Cardona, Ken ; Staley, Charles A. ; Maithel, Shishir K.</creator><creatorcontrib>Squires III, Malcolm H. ; Kooby, David A. ; Poultsides, George A. ; Pawlik, Timothy M. ; Weber, Sharon M. ; Schmidt, Carl R. ; Votanopoulos, Konstantinos I. ; Fields, Ryan C. ; Ejaz, Aslam ; Acher, Alexandra W. ; Worhunsky, David J. ; Saunders, Neil ; Levine, Edward A. ; Jin, Linda X. ; Cho, Clifford S. ; Bloomston, Mark ; Winslow, Emily R. ; Russell, Maria C. ; Cardona, Ken ; Staley, Charles A. ; Maithel, Shishir K.</creatorcontrib><description>Background
A proximal margin distance of 5 cm is advocated for resection of gastric adenocarcinoma (GAC). We assessed the prognostic value of proximal margin (PM) distance on survival outcomes after resection of distal GAC.
Methods
All patients who underwent resection of distal GAC (antrum/body) from 2000 to 2012 at seven institutions of the U.S. Gastric Cancer Collaborative were included. Patients with positive distal margins or macroscopic residual disease were excluded. The prognostic value of PM distance (assessed in 0.5-cm increments) on overall (OS) and recurrence-free survival (RFS) was assessed by Kaplan–Meier and multivariate regression analysis.
Results
A total of 465 patients underwent resection of distal GAC. Of these, 435 had R0 resections; 30 patients had a positive PM. 143 patients had stage I, and 322 had stage II–III tumors. Median follow-up was 44 months. Average PM distance was 4.8 cm. Median OS for patients with PM of 3.1–5.0 cm (
n
= 110) was superior to patients with PM ≤ 3.0 cm (
n
= 176) (48.1 vs. 29.3 months;
p
= 0.01), while a margin >5.0 cm (
n
= 179) offered equivalent survival to PM 3.1–5.0 cm (50.6 months,
p
= 0.72). The prognostic value of margin distance was stage specific. On multivariate analysis of stage I patients, PM 3.1–5.0 cm remained associated with improved OS [hazard ratio (HR), 0.16; 95 % confidence interval (95 % CI), 0.04–0.60;
p
= 0.01]. In stage II–III, neither PM 3.1–5.0 cm nor PM > 5.0 cm was significantly associated with OS; OS was dictated by T stage and nodal involvement.
Conclusions
The prognostic value of proximal margin distance after resection of distal gastric cancer appears stage specific. In stage I, a 3.1- to 5.0-cm proximal margin is associated with the same improved OS as a > 5.0-cm margin. In stage II–III disease, other adverse pathologic factors more strongly impact survival than proximal margin distance.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-014-4138-z</identifier><identifier>PMID: 25316491</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Aged ; Carcinoma, Signet Ring Cell - mortality ; Carcinoma, Signet Ring Cell - pathology ; Carcinoma, Signet Ring Cell - surgery ; Female ; Follow-Up Studies ; Gastrointestinal Oncology ; Humans ; Male ; Medicine ; Medicine & Public Health ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - surgery ; Neoplasm Staging ; Oncology ; Prognosis ; Stomach Neoplasms - mortality ; Stomach Neoplasms - pathology ; Stomach Neoplasms - surgery ; Surgery ; Surgical Oncology ; Survival Rate</subject><ispartof>Annals of surgical oncology, 2015-04, Vol.22 (4), p.1243-1251</ispartof><rights>Society of Surgical Oncology 2014</rights><rights>Society of Surgical Oncology 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-d83f92904182ab22320aea064c32e2815166518aa7ac51306b49f916bf4163c63</citedby><cites>FETCH-LOGICAL-c372t-d83f92904182ab22320aea064c32e2815166518aa7ac51306b49f916bf4163c63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-014-4138-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-014-4138-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25316491$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Squires III, Malcolm H.</creatorcontrib><creatorcontrib>Kooby, David A.</creatorcontrib><creatorcontrib>Poultsides, George A.</creatorcontrib><creatorcontrib>Pawlik, Timothy M.</creatorcontrib><creatorcontrib>Weber, Sharon M.</creatorcontrib><creatorcontrib>Schmidt, Carl R.</creatorcontrib><creatorcontrib>Votanopoulos, Konstantinos I.</creatorcontrib><creatorcontrib>Fields, Ryan C.</creatorcontrib><creatorcontrib>Ejaz, Aslam</creatorcontrib><creatorcontrib>Acher, Alexandra W.</creatorcontrib><creatorcontrib>Worhunsky, David J.</creatorcontrib><creatorcontrib>Saunders, Neil</creatorcontrib><creatorcontrib>Levine, Edward A.</creatorcontrib><creatorcontrib>Jin, Linda X.</creatorcontrib><creatorcontrib>Cho, Clifford S.</creatorcontrib><creatorcontrib>Bloomston, Mark</creatorcontrib><creatorcontrib>Winslow, Emily R.</creatorcontrib><creatorcontrib>Russell, Maria C.</creatorcontrib><creatorcontrib>Cardona, Ken</creatorcontrib><creatorcontrib>Staley, Charles A.</creatorcontrib><creatorcontrib>Maithel, Shishir K.</creatorcontrib><title>Is It Time to Abandon the 5-cm Margin Rule During Resection of Distal Gastric Adenocarcinoma? A Multi-Institution Study of the U.S. Gastric Cancer Collaborative</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
A proximal margin distance of 5 cm is advocated for resection of gastric adenocarcinoma (GAC). We assessed the prognostic value of proximal margin (PM) distance on survival outcomes after resection of distal GAC.
Methods
All patients who underwent resection of distal GAC (antrum/body) from 2000 to 2012 at seven institutions of the U.S. Gastric Cancer Collaborative were included. Patients with positive distal margins or macroscopic residual disease were excluded. The prognostic value of PM distance (assessed in 0.5-cm increments) on overall (OS) and recurrence-free survival (RFS) was assessed by Kaplan–Meier and multivariate regression analysis.
Results
A total of 465 patients underwent resection of distal GAC. Of these, 435 had R0 resections; 30 patients had a positive PM. 143 patients had stage I, and 322 had stage II–III tumors. Median follow-up was 44 months. Average PM distance was 4.8 cm. Median OS for patients with PM of 3.1–5.0 cm (
n
= 110) was superior to patients with PM ≤ 3.0 cm (
n
= 176) (48.1 vs. 29.3 months;
p
= 0.01), while a margin >5.0 cm (
n
= 179) offered equivalent survival to PM 3.1–5.0 cm (50.6 months,
p
= 0.72). The prognostic value of margin distance was stage specific. On multivariate analysis of stage I patients, PM 3.1–5.0 cm remained associated with improved OS [hazard ratio (HR), 0.16; 95 % confidence interval (95 % CI), 0.04–0.60;
p
= 0.01]. In stage II–III, neither PM 3.1–5.0 cm nor PM > 5.0 cm was significantly associated with OS; OS was dictated by T stage and nodal involvement.
Conclusions
The prognostic value of proximal margin distance after resection of distal gastric cancer appears stage specific. In stage I, a 3.1- to 5.0-cm proximal margin is associated with the same improved OS as a > 5.0-cm margin. In stage II–III disease, other adverse pathologic factors more strongly impact survival than proximal margin distance.</description><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged</subject><subject>Carcinoma, Signet Ring Cell - mortality</subject><subject>Carcinoma, Signet Ring Cell - pathology</subject><subject>Carcinoma, Signet Ring Cell - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastrointestinal Oncology</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Neoplasm Staging</subject><subject>Oncology</subject><subject>Prognosis</subject><subject>Stomach Neoplasms - mortality</subject><subject>Stomach Neoplasms - pathology</subject><subject>Stomach Neoplasms - surgery</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival Rate</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kdtqFTEUhoMo9qAP4I0EvPFmtlk5zcyVbHZt3dAi9HA9ZDKZmjKTbHMotE_jo5px1yKCVwnh-_-1yIfQOyAroFx8ikA44xUBXnFgTfX4Ah2CKC9cNvCy3IlsqpZKcYCOYrwjBGpGxGt0QAUDyVs4RD-3EW8Tvrazwcnjda_c4B1O3w0WlZ7xhQq31uHLPBl8koN1t_jSRKOTLZQf8YmNSU34TMUUrMbrwTivVdDW-Vl9xmt8kadkq62Lyab8O3WV8vCwZJchN6ur1XN6o5w2AW_8NKneB5XsvXmDXo1qiubt03mMbk6_XG--Vuffzrab9XmlWU1TNTRsbGlLODRU9ZQySpRRRHLNqKENCJBSQKNUrbQARmTP27EF2Y8cJNOSHaOP-95d8D-yiambbdSmbOKMz7Er-VJely8t6Id_0DufgyvbFUo0LdSiEYWCPaWDjzGYsdsFO6vw0AHpFn3dXl9X9HWLvu6xZN4_Ned-NsNz4o-vAtA9EHeLCxP-Gv3f1l8fW6QC</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Squires III, Malcolm H.</creator><creator>Kooby, David A.</creator><creator>Poultsides, George A.</creator><creator>Pawlik, Timothy M.</creator><creator>Weber, Sharon M.</creator><creator>Schmidt, Carl R.</creator><creator>Votanopoulos, Konstantinos I.</creator><creator>Fields, Ryan C.</creator><creator>Ejaz, Aslam</creator><creator>Acher, Alexandra W.</creator><creator>Worhunsky, David J.</creator><creator>Saunders, Neil</creator><creator>Levine, Edward A.</creator><creator>Jin, Linda X.</creator><creator>Cho, Clifford S.</creator><creator>Bloomston, Mark</creator><creator>Winslow, Emily R.</creator><creator>Russell, Maria C.</creator><creator>Cardona, Ken</creator><creator>Staley, Charles A.</creator><creator>Maithel, Shishir K.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20150401</creationdate><title>Is It Time to Abandon the 5-cm Margin Rule During Resection of Distal Gastric Adenocarcinoma? A Multi-Institution Study of the U.S. Gastric Cancer Collaborative</title><author>Squires III, Malcolm H. ; Kooby, David A. ; Poultsides, George A. ; Pawlik, Timothy M. ; Weber, Sharon M. ; Schmidt, Carl R. ; Votanopoulos, Konstantinos I. ; Fields, Ryan C. ; Ejaz, Aslam ; Acher, Alexandra W. ; Worhunsky, David J. ; Saunders, Neil ; Levine, Edward A. ; Jin, Linda X. ; Cho, Clifford S. ; Bloomston, Mark ; Winslow, Emily R. ; Russell, Maria C. ; Cardona, Ken ; Staley, Charles A. ; Maithel, Shishir K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-d83f92904182ab22320aea064c32e2815166518aa7ac51306b49f916bf4163c63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Aged</topic><topic>Carcinoma, Signet Ring Cell - mortality</topic><topic>Carcinoma, Signet Ring Cell - pathology</topic><topic>Carcinoma, Signet Ring Cell - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastrointestinal Oncology</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neoplasm Recurrence, Local - mortality</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Neoplasm Staging</topic><topic>Oncology</topic><topic>Prognosis</topic><topic>Stomach Neoplasms - mortality</topic><topic>Stomach Neoplasms - pathology</topic><topic>Stomach Neoplasms - surgery</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Squires III, Malcolm H.</creatorcontrib><creatorcontrib>Kooby, David A.</creatorcontrib><creatorcontrib>Poultsides, George A.</creatorcontrib><creatorcontrib>Pawlik, Timothy M.</creatorcontrib><creatorcontrib>Weber, Sharon M.</creatorcontrib><creatorcontrib>Schmidt, Carl R.</creatorcontrib><creatorcontrib>Votanopoulos, Konstantinos I.</creatorcontrib><creatorcontrib>Fields, Ryan C.</creatorcontrib><creatorcontrib>Ejaz, Aslam</creatorcontrib><creatorcontrib>Acher, Alexandra W.</creatorcontrib><creatorcontrib>Worhunsky, David J.</creatorcontrib><creatorcontrib>Saunders, Neil</creatorcontrib><creatorcontrib>Levine, Edward A.</creatorcontrib><creatorcontrib>Jin, Linda X.</creatorcontrib><creatorcontrib>Cho, Clifford S.</creatorcontrib><creatorcontrib>Bloomston, Mark</creatorcontrib><creatorcontrib>Winslow, Emily R.</creatorcontrib><creatorcontrib>Russell, Maria C.</creatorcontrib><creatorcontrib>Cardona, Ken</creatorcontrib><creatorcontrib>Staley, Charles A.</creatorcontrib><creatorcontrib>Maithel, Shishir K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Squires III, Malcolm H.</au><au>Kooby, David A.</au><au>Poultsides, George A.</au><au>Pawlik, Timothy M.</au><au>Weber, Sharon M.</au><au>Schmidt, Carl R.</au><au>Votanopoulos, Konstantinos I.</au><au>Fields, Ryan C.</au><au>Ejaz, Aslam</au><au>Acher, Alexandra W.</au><au>Worhunsky, David J.</au><au>Saunders, Neil</au><au>Levine, Edward A.</au><au>Jin, Linda X.</au><au>Cho, Clifford S.</au><au>Bloomston, Mark</au><au>Winslow, Emily R.</au><au>Russell, Maria C.</au><au>Cardona, Ken</au><au>Staley, Charles A.</au><au>Maithel, Shishir K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is It Time to Abandon the 5-cm Margin Rule During Resection of Distal Gastric Adenocarcinoma? A Multi-Institution Study of the U.S. Gastric Cancer Collaborative</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>22</volume><issue>4</issue><spage>1243</spage><epage>1251</epage><pages>1243-1251</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
A proximal margin distance of 5 cm is advocated for resection of gastric adenocarcinoma (GAC). We assessed the prognostic value of proximal margin (PM) distance on survival outcomes after resection of distal GAC.
Methods
All patients who underwent resection of distal GAC (antrum/body) from 2000 to 2012 at seven institutions of the U.S. Gastric Cancer Collaborative were included. Patients with positive distal margins or macroscopic residual disease were excluded. The prognostic value of PM distance (assessed in 0.5-cm increments) on overall (OS) and recurrence-free survival (RFS) was assessed by Kaplan–Meier and multivariate regression analysis.
Results
A total of 465 patients underwent resection of distal GAC. Of these, 435 had R0 resections; 30 patients had a positive PM. 143 patients had stage I, and 322 had stage II–III tumors. Median follow-up was 44 months. Average PM distance was 4.8 cm. Median OS for patients with PM of 3.1–5.0 cm (
n
= 110) was superior to patients with PM ≤ 3.0 cm (
n
= 176) (48.1 vs. 29.3 months;
p
= 0.01), while a margin >5.0 cm (
n
= 179) offered equivalent survival to PM 3.1–5.0 cm (50.6 months,
p
= 0.72). The prognostic value of margin distance was stage specific. On multivariate analysis of stage I patients, PM 3.1–5.0 cm remained associated with improved OS [hazard ratio (HR), 0.16; 95 % confidence interval (95 % CI), 0.04–0.60;
p
= 0.01]. In stage II–III, neither PM 3.1–5.0 cm nor PM > 5.0 cm was significantly associated with OS; OS was dictated by T stage and nodal involvement.
Conclusions
The prognostic value of proximal margin distance after resection of distal gastric cancer appears stage specific. In stage I, a 3.1- to 5.0-cm proximal margin is associated with the same improved OS as a > 5.0-cm margin. In stage II–III disease, other adverse pathologic factors more strongly impact survival than proximal margin distance.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>25316491</pmid><doi>10.1245/s10434-014-4138-z</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2015-04, Vol.22 (4), p.1243-1251 |
| issn | 1068-9265 1534-4681 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1660417106 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - surgery Aged Carcinoma, Signet Ring Cell - mortality Carcinoma, Signet Ring Cell - pathology Carcinoma, Signet Ring Cell - surgery Female Follow-Up Studies Gastrointestinal Oncology Humans Male Medicine Medicine & Public Health Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - surgery Neoplasm Staging Oncology Prognosis Stomach Neoplasms - mortality Stomach Neoplasms - pathology Stomach Neoplasms - surgery Surgery Surgical Oncology Survival Rate |
| title | Is It Time to Abandon the 5-cm Margin Rule During Resection of Distal Gastric Adenocarcinoma? A Multi-Institution Study of the U.S. Gastric Cancer Collaborative |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-19T00%3A27%3A36IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Is%20It%20Time%20to%20Abandon%20the%205-cm%20Margin%20Rule%20During%20Resection%20of%20Distal%20Gastric%20Adenocarcinoma?%20A%20Multi-Institution%20Study%20of%20the%20U.S.%20Gastric%20Cancer%20Collaborative&rft.jtitle=Annals%20of%20surgical%20oncology&rft.au=Squires%20III,%20Malcolm%20H.&rft.date=2015-04-01&rft.volume=22&rft.issue=4&rft.spage=1243&rft.epage=1251&rft.pages=1243-1251&rft.issn=1068-9265&rft.eissn=1534-4681&rft_id=info:doi/10.1245/s10434-014-4138-z&rft_dat=%3Cproquest_cross%3E1660417106%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1658917585&rft_id=info:pmid/25316491&rfr_iscdi=true |