Association of proximal, distal resection margin distances in R0 gastrectomy with prognosis of gastric cancer

Abstract

Objective To investigate the association of proximal and distal resection margin(PRM/DRM)distances in R0 gastrectomy with the prognosis of gastric cancer patients with no distant metastases.Methods From Jan.2008 to Nov.2009,a total of 288 patients with gastric cancer were selected;they received radical and R0 gastrectomy,with pathological diagnosis after surgery and with complete pathological and follow-up data.The relationship of the pathological parameters with the PRM,DRM distance was analyzed.Univariate and multivariate analyses were performed to indentify the independent risk factors of prognosis and to evaluate the association between PRM,DRM distance and overall survival(OS).Results Increased PRM distance was significantly correlated with tumor location at the lower third of the stomach(P0.001).Increased DRM distance was significantly correlated with an early T-stage(P=0.044 2),tumor location at the middle third of stomch(P=0.008 4),smaller tumor size(P=0.024 1),normal preoperative serum markers(P=0.013 2)and total gastrectomy(P=0.001 7).Univariate analysis showed that PRM distance(P=0.650)and DRM distance(P=0.095)were not significantly correlated with gastric cancer survival,and they did not significantly influence locoregional recurrence or distant recurrence.Multivariate analysis showed that the independent prognostic factor for gastric cancer included N-stage,tumor location,tumor size,and presence of lymphatic invasion;also PRM distance(P=0.650)and DRM distance(P=0.095)had no significant influence on the survival of gastric cancer patients.Subgroup analysis showed that PRM distance had no significant influence on the overall survival(P=0.312)in N-stage N0+N1group,but DRM distance had significant difference on the overall survival(P=0.011)in N0+N1group.Conclusion PRM and DRM distance are not the independent risk factors for the overall survival of gastric cancer patients undergoing R0 gastrectomy.DRM distance of more than 2cm can markedly improve the prognosis of the patients with less than 3metastatic lymph nodes.