MARGINS OF RESECTION OF THE ESOPHAGUS FOR GASTRIC-CANCER WITH ESOPHAGEAL INVASION

Background/Aims: We retrospectively examined the rate of infiltration of proximal margins of resection in patients resected for gastric canc er with esophageal invasion. Material and Methods: In the 175 proximal margins examined, the incidence was related to the gross appearance, histologic type, size, depth of invasion, shape of the oral edge, Leng th of grossly tumor-free edge and length of histologic esophageal inva sion. Results: Multivariate analysis indicated that undifferentiated a denocarcinoma and length of histologic esophageal invasion are signifi cant risk factors for positive margin. Infiltration occurred in 13.7% (24 cases) of the oral margins of transection. Eight patients were pot entially curative other than positive margin and 5 were caused by unde restimation of the distance of oral margin. With reference to the leng th of margin of resection, no involvement was found when the cranial d istance between the lesion and the line of transection. exceeded 2 cm in patients with orally well-defined type esophageal invasion. In. pat ients with the orally ill-defined type, transection with a distance gr eater than 4 cm commonly guarantee safety of the proximal margin, exce pt for cases with lymphatic invasion. Conclusions: These data provide the surgeon. with a rational basis for assessing the extent of resecti on when performing esophagectomy combined with gastrectomy for cancer.