Influence of a Positive Proximal Margin on Oral Intake in Patients with Palliative Gastrectomy for Far Advanced Gastric Cancer

Abstract

Resection margin involvement is one of the most significant risk factors for local recurrence in curative gastrectomy, and local recurrence results in anastomotic stenosis. In the present study, the effects of a positive resection margin in palliative gastrectomy on the symptoms of anastomotic stenosis and the amount of oral intake were analyzed. Between September 2002 and December 2009, 2,228 patients underwent resection for gastric cancer at Shizuoka Cancer Center, Japan, of whom 18 underwent palliative gastrectomy with a positive proximal margin because of urgent symptoms such as tumor bleeding, stenosis, or perforation. These 18 patients were analyzed retrospectively in this study. Twelve patients had a positive proximal margin, and six patients had both proximal and distal margin involvement. Anastomotic leakage occurred in 2 patients. The median overall survival was 7.5months, and the median time from operation to a decrease in oral intake was 5.5months. Anastomotic recurrence developed in 3 patients, and in all of them, anastomotic stricture was found 2-3months after gastrectomy. One of these patients, who was in good general condition, was treated by endoscopic balloon dilatation. The other 2 patients did not undergo balloon dilatation because their general condition was poor, with peritonitis carcinomatosa. It does not appear necessary for palliative gastrectomy to achieve a negative proximal margin, because salvage therapies resulted in maintaining a tolerable oral intake in patients who were in good general condition.