Abstract
Ensuring a pathologically negative distal margin (DM) and preserving a larger remnant stomach is important for proximal gastrectomy (PG) in patients with esophagogastric junction (EGJ) cancer. However, the minimum DM length for ensuring negative margins has not been identified. We enrolled patients undergoing PG or total gastrectomy for EGJ cancer. A parameter ΔDM, representing the pathological extension distally beyond the gross tumor boundary, was evaluated. The maximum ΔDM, which indicates the minimum length ensuring a pathologically negative DM, was determined in all patients. Subgroup analyses were performed according to factors associated with ΔDM > 10mm. The possible incidences of pathologically positive DM based on gross DM length were also calculated. Among 253 eligible patients, the maximum ΔDM was 55mm. Growth and pathological types were significantly associated with ΔDM > 10mm. In subgroup analyses, the maximum ΔDM was 30/20/55mm for the superficial/expansive/infiltrative growth types, and 55/40mm for the differentiated/undifferentiated types. In the infiltrative growth type alone, the maximum ΔDM remained 55/40mm for the differentiated/undifferentiated types. However, even if the gross DM length was reduced to 30mm, the possible incidence of pathologically positive DM only increased to 2.6% in the infiltrative differentiated type. We recommend a minimum DM length of 30/20/55mm for the superficial/expansive/ infiltrative growth types. Specifically in the infiltrative growth type, we alternatively recommend 30/40mm for the differentiated/undifferentiated types, with a mandatory intraoperative frozen section analysis. Mini-abstract This study proposes a distal margin length for safe resection of esophagogastric junction cancer, ensuring pathologically negative margins while preserving a larger remnant stomach, based on growth and pathological types.
Published Version
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