Updates in Surgery

, Volume 70, Issue 2, pp 213–223 | Cite as

Resection line involvement after gastric cancer treatment: handle with care

  • Paolo MorgagniEmail author
  • Giuliano La Barba
  • Eleonora Colciago
  • Giovanni Vittimberga
  • Giorgio Ercolani
Review Article
Part of the following topical collections:
  1. Gastric Cancer Surgery


The optimal management of patients with resection line involvement after endoscopic or surgical treatment for gastric cancer is debated. In contrast to previous reports, we examined both the experience of endoscopists and surgeons in early-stage lesions and the wide variation in treatments proposed for advanced disease in case of infiltration of resection margins. A PubMed search for papers using the key words: gastric or stomach cancer, or Carcinoma; gastrectomy and positive margins; surgical margins or resection line or endoscopic margin involvement; and R1 resection, from January 2000 to July 2015 was undertaken. Fifty-three studies were considered pertinent to the study. Many endoscopists report that some cases of early gastric cancer with resection line involvement after endoscopic resection have good outcomes notwithstanding incomplete resection, but few surgeons share this opinion. Conversely, it is unanimously agreed that very advanced stages should not be surgically retreated because they are expression of systemic disease. Between early and very advanced cancer the usefulness of re-resection for microscopic resection lines involvement is still debated and surgery may be proposed only when radicality can be achieved. When surgery is not feasible, radiochemotherapy may represent a valid alternative.


Resection line involvement Infiltrated resection margin Gastric cancer Frozen section Endoscopic submucosal dissection R1 resection Radiochemotherapy 



The authors thank Gráinne Tierney for editorial assistance.

Author contributions

All authors contributed equally to this paper.



Compliance with ethical standards

Conflicts of interest

There are no conflicts of interest to declare for this paper.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Italian Society of Surgery (SIC) 2018

Authors and Affiliations

  • Paolo Morgagni
    • 1
    Email author
  • Giuliano La Barba
    • 1
  • Eleonora Colciago
    • 2
  • Giovanni Vittimberga
    • 1
  • Giorgio Ercolani
    • 1
  1. 1.Department of General SurgeryMorgagni-Pierantoni HospitalForlìItaly
  2. 2.Department of Surgery and Translational MedicineMilano-Bicocca University, San Gerardo HospitalMonzaItaly

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