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Utility of the Proximal Margin Frozen Section for Resection of Gastric Adenocarcinoma: A 7-Institution Study of the US Gastric Cancer Collaborative

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The proximal gastric margin dictates the extent of resection for gastric adenocarcinoma (GAC). The value of achieving negative margins via additional gastric resection after a positive proximal margin frozen section (FS) is unknown.

Methods

The US Gastric Cancer Collaborative includes all patients who underwent resection of GAC at seven institutions from 2000–2012. Intraoperative proximal margin FS data and final permanent section (PS) data were classified as R0 or R1, respectively; positive distal margins were excluded. The primary aim was to evaluate the impact on local recurrence of converting a positive proximal FS-R1 margin to a PS-R0 final margin by additional resection. Secondary endpoints were recurrence-free survival (RFS) and overall survival (OS).

Results

Of 860 patients, 520 had a proximal margin FS and 67 were positive. Of these, 48 were converted to R0 on PS by additional resection. R0 proximal margin was achieved in 447 patients (86 %), PS-R1 in 25 (5 %), and converted FS-R1-to-PS-R0 in 48 (9 %). The median follow-up was 44 months. Local recurrence was significantly decreased in the converted FS-R1-to-PS-R0 group compared to the PS-R1 group (10 vs. 32 %; p = 0.01). Median RFS was similar between the FS-R1-to-PS-R0 and PS-R1 cohorts (25 vs. 20 months; p = 0.49), compared to 37 months for the PS-R0 group. Median OS was similar between the FS-R1-to-PS-R0 conversion and PS-R1 groups (36 vs. 26 months; p = 0.14) compared to 50 months for the PS-R0 group. On multivariate analysis, increasing T-stage and N-stage were associated with worse OS; the FS-R1-to-PS-R0 proximal margin conversion was not significantly associated with improved RFS (p = 0.68) or OS (p = 0.44).

Conclusion

Conversion of a positive intraoperative proximal margin frozen section during gastric cancer resection may decrease local recurrence, but it is not associated with improved RFS or OS. This may guide decisions regarding the extent of resection.

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Acknowledgment

This study is supported in part by the Katz Foundation.

Disclosure

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Malcolm H. Squires III MD, MS, David A. Kooby MD, Kenneth Cardona MD, Charles A. Staley III MD & Shishir K. Maithel MD

  2. Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Timothy M. Pawlik MD, MPH, PhD & Aslam Ejaz MD

  3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber MD, Alexandra W. Acher BS, Clifford S. Cho MD & Emily Winslow MD

  4. Department of Surgery, Stanford University Medical Center, Palo Alto, CA, USA

    George Poultsides MD & David J. Worhunsky MD

  5. Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Carl Schmidt MD, Neil Saunders MD & Mark Bloomston MD

  6. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Konstantinos Votanopoulos MD & Edward Levine MD

  7. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA

    Ryan C. Fields MD & Linda X. Jin MD

Authors
  1. Malcolm H. Squires III MD, MS
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  2. David A. Kooby MD
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  3. Timothy M. Pawlik MD, MPH, PhD
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  4. Sharon M. Weber MD
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  5. George Poultsides MD
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  6. Carl Schmidt MD
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  7. Konstantinos Votanopoulos MD
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  8. Ryan C. Fields MD
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  9. Aslam Ejaz MD
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  10. Alexandra W. Acher BS
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  11. David J. Worhunsky MD
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  12. Neil Saunders MD
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  13. Linda X. Jin MD
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  14. Edward Levine MD
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  15. Clifford S. Cho MD
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  16. Mark Bloomston MD
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  17. Emily Winslow MD
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  18. Kenneth Cardona MD
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  19. Charles A. Staley III MD
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  20. Shishir K. Maithel MD
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Corresponding author

Correspondence to Shishir K. Maithel MD.

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Squires, M.H., Kooby, D.A., Pawlik, T.M. et al. Utility of the Proximal Margin Frozen Section for Resection of Gastric Adenocarcinoma: A 7-Institution Study of the US Gastric Cancer Collaborative . Ann Surg Oncol 21, 4202–4210 (2014). https://doi.org/10.1245/s10434-014-3834-z

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  • DOI: https://doi.org/10.1245/s10434-014-3834-z

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