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Significance of a Positive Oesophageal Margin in Stomach Cancer
Author(s) -
Chan W. H.,
Wong W. K.,
Khin L. W.,
Chan H. S.,
Soo K. C.
Publication year - 2000
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1046/j.1440-1622.2000.01937.x
Subject(s) - medicine , anastomosis , gastrectomy , proportional hazards model , resection margin , gastroenterology , stomach , retrospective cohort study , margin (machine learning) , cancer , dehiscence , stage (stratigraphy) , surgical margin , surgery , multivariate analysis , general surgery , resection , paleontology , machine learning , computer science , biology
Background : A positive oesophageal margin is frequently encountered in total and proximal gastrectomies. It is controversial as to whether a positive oesophageal margin in gastrectomy predisposes to anastomotic dehiscence and loco‐regional recurrence. Its independent impact on survival has not been fully addressed. Methods : A retrospective review of 137 total and proximal gastrectomies for adenocarcinoma was undertaken. Independent prognostic factors were identified in a bivariate and Cox proportional hazards regression model. Results : The prevalence of positive oesophageal margin was 18.2%. A positive oesophageal margin was not associated with increased anastomotic leak (8.0 vs 10.7%; P = 0.51), operative morbidity (32.0 vs 27.7%; P = 0.85) or 30‐day mortality (8.0 vs 5.4%; P = 0.48) rates when compared with a negative margin. In addition, it did not predispose to anastomotic (13.0 vs 10.4%; P = 0.47) or regional (22.7 vs 24.5%; P = 0.51) recurrences. In the multivariate analysis the TNM stage and status of the oesophageal margin were the only independent prognostic factors for survival. Conclusions : A positive oesophageal margin is an independent poor prognostic factor for long‐term survival in stomach cancer. All efforts should therefore be made to clear the oesophageal margin in total and proximal gastrectomies.