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Annals of Surgical Oncology

, Volume 21, Issue 13, pp 4202–4210 | Cite as

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

  • Malcolm H. SquiresIII
  • David A. Kooby
  • Timothy M. Pawlik
  • Sharon M. Weber
  • George Poultsides
  • Carl Schmidt
  • Konstantinos Votanopoulos
  • Ryan C. Fields
  • Aslam Ejaz
  • Alexandra W. Acher
  • David J. Worhunsky
  • Neil Saunders
  • Linda X. Jin
  • Edward Levine
  • Clifford S. Cho
  • Mark Bloomston
  • Emily Winslow
  • Kenneth Cardona
  • Charles A. StaleyIII
  • Shishir K. Maithel
Gastrointestinal Oncology

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.

Keywords

Overall Survival Freeze Section Permanent Section Proximal Margin Linitis Plastica 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This study is supported in part by the Katz Foundation.

Disclosure

None

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Malcolm H. SquiresIII
    • 1
  • David A. Kooby
    • 1
  • Timothy M. Pawlik
    • 2
  • Sharon M. Weber
    • 3
  • George Poultsides
    • 4
  • Carl Schmidt
    • 5
  • Konstantinos Votanopoulos
    • 6
  • Ryan C. Fields
    • 7
  • Aslam Ejaz
    • 2
  • Alexandra W. Acher
    • 3
  • David J. Worhunsky
    • 4
  • Neil Saunders
    • 5
  • Linda X. Jin
    • 7
  • Edward Levine
    • 6
  • Clifford S. Cho
    • 3
  • Mark Bloomston
    • 5
  • Emily Winslow
    • 3
  • Kenneth Cardona
    • 1
  • Charles A. StaleyIII
    • 1
  • Shishir K. Maithel
    • 1
  1. 1.Division of Surgical Oncology, Department of Surgery, Winship Cancer InstituteEmory UniversityAtlantaUSA
  2. 2.Division of Surgical OncologyThe Johns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  4. 4.Department of SurgeryStanford University Medical CenterPalo AltoUSA
  5. 5.Department of SurgeryThe Ohio State University Comprehensive Cancer CenterColumbusUSA
  6. 6.Department of SurgeryWake Forest UniversityWinston-SalemUSA
  7. 7.Department of SurgeryWashington University School of MedicineSt LouisUSA

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