Prognostic impact of resection margin involvement after extended (D2/D3) gastrectomy for advanced gastric cancer: A 15‐year experience at a single institute

Background and Objectives The aim of this study was to investigate whether microscopic positive margins are detrimental to the outcome of gastric cancer patients treated with extended (D2/3) gastrectomy. Methods Among 2,740 consecutive patients who had undergone extended gastrectomy for advanced gastric cancer between January 1987 and December 2002, 49 patients (1.8%) had positive resection margins on final histology. Results Among 49 patients, 29 (59.2%) had proximal involved margins and 20 (40.8%) had distal involved margins. The median survival time of the positive margin group was 34 months. The negative margin group had a significantly longer median survival time of 69 months ( P  = 0.025). When both groups of patients were stratified according to nodal stage, a positive resection margin determined a worse prognosis only in patients with node‐negative disease (174 months vs. 37 months, P  = 0.0001). In patients with nodal metastasis, the median survival time was similar in both groups. Conclusions Our results suggest that a positive microscopic margin is associated with a worse outcome in patients with node‐negative disease. Therefore, a more aggressive treatment, such as re‐operation, is needed in node‐negative patients with a positive microscopic disease. J. Surg. Oncol. 2007; 95: 461–468. © 2006 Wiley‐Liss, Inc.