CLINICOPATHOLOGICAL CHARACTERISTICS OF GASTRIC-CANCER PATIENTS WITH CANCER INFILTRATION AT SURGICAL MARGIN AT GASTRECTOMY

Although curative surgery is desirable in patients with gastric cancer , tumors adjacent to the esophagogastric and/or gastroduodenal junctio ns present surgeons with some difficulty in estimating whether or not the lesion has infiltrated beyond the surgial margin. We report herein a retrospective analysis with respect to the clinicopathologic featur es of the primary lesion and margin positivity for tumor cells. Betwee n 1982 and 1993, 861 gastric cancer patients underwent gastrectomy in our clinics. Of these, 340 had early cancer and the remaining 521 adva nced cancel: Cancel infiltration at the surgical margin was determined macroscopically in the fresh resected specimen; re-resection was carr ied out immediately for positive cases and, subsequently, a rapid hist ologic examination at the newly-incised edge was carried out intraoper atively. Of the 340 patients with early cancel; 15 (4.4%) had a positi ve surgical margin which was directly resected successfully. Of the 52 1 patients with advanced cancer; 73 (14%) had a positive surgical marg in and 28 of them had a microscopically negative surgical edge after r e-resection; however; 8 others had a positive result at the newly-exci sed edge after. re-resection, and the remaining 37 could not undergo r e-resection because of their poor general condition and/or because the tumor. had spread to other sites. The positive rate for the final sur gical margin was 5.2% (45/861 patients). All of the patients with a po sitive margin and early cancer had a superficial or excavative type le sion, and 76.7% (56/73 patients) of those with advanced cancer had Bor rmann's III or IV type lesion. These findings suggest that in such pat ients with a tumor adjacent to the esophagogastric and/or gastroduoden al junctions, particular attention should be paid to Borrmann's III or lesions in advanced cancel and to superficial oi excavated type lesio ns in early cancer in order to reduce the frequency of positive surgic al margin. Additionally an immediate histologic examination after re-r esection is extremely important.