What is Ideal Proximal Resection Margin in Carcinoma Stomach

Objective: The goal of cancer surgery is to achieve clear margins, where the surgeon resects the tumor along with normal adjacent tissue and pathologist confirms the absence of cancer cells of the margin of this resected tissue. Complete resection with negative surgical margins along with lymph node dissection has been accepted as the only possible curative treatment for gastric cancer. Although there have been several studies on the sufficient length of margins that guarantees tumor-free resection and prevents local recurrences, definite consensus has not yet been reached, especially about the proximal resection margin (PRM). Methods: The study was conducted in the Department of General Surgery, Sher I Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India between September 2011 and September 20013 and a total of 115 patients of ca stomach were included in the study. PRM of resected specimen was undertaken at 0.5cm, 1cm, 1.5cm, 2cm, 2.5cm, 3cm, 3.5cm, 4cm, 5cm and 6cm. A resection margin was considered positive if permanent section examination revealed tumor tissue at the line of transaction. The relation between infiltration of margins and various parameters of tumor-like location, size, histological type and depth of invasion into gastric wall was determined. The difference in the distribution and rate of margin infiltration was statistically evaluated, and a probability equal to or less than 0.05 was accepted as significant. Results: Out of 115 patients of ca stomach who underwent partial or total gastrectomy, proximal margin infiltration was seen in 5 patients (4.35%). No infiltration of proximal margin was seen when the length of the resected margin was >50mm. Margin infiltration was commonly found in tumors located at upper third, in diffuse histological type and with lymph node metastasis. Conclusion: Since tumor infiltration at resection lines has been accepted as an adverse prognostic factor, negative resection margin are crucial components of curative surgery. Achieving a negative resection margin is the ultimate goal when determining the adequate length for PRM. In our study, we found that a PRM of greater than 5 cm is ideal for having a negative resection margin for all grades, sizes and T & N stages of carcinoma stomach. JMS 2018;21(1):31-36