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Background <p>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.</p> Methods <p>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 &gt; 10&#xa0;mm. The possible incidences of pathologically positive DM based on gross DM length were also calculated.</p> Results <p>Among 253 eligible patients, the maximum ΔDM was 55&#xa0;mm. Growth and pathological types were significantly associated with ΔDM &gt; 10&#xa0;mm. In subgroup analyses, the maximum ΔDM was 30/20/55&#xa0;mm for the superficial/expansive/infiltrative growth types, and 55/40&#xa0;mm for the differentiated/undifferentiated types. In the infiltrative growth type alone, the maximum ΔDM remained 55/40&#xa0;mm for the differentiated/undifferentiated types. However, even if the gross DM length was reduced to 30&#xa0;mm, the possible incidence of pathologically positive DM only increased to 2.6% in the infiltrative differentiated type.</p> Conclusion <p>We recommend a minimum DM length of 30/20/55&#xa0;mm for the superficial/expansive/ infiltrative growth types. Specifically in the infiltrative growth type, we alternatively recommend 30/40&#xa0;mm for the differentiated/undifferentiated types, with a mandatory intraoperative frozen section analysis.</p> <p>Mini-abstract</p> <p>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.</p>

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Minimum resection length to ensure a pathologically negative distal margin and a larger remnant stomach for esophagogastric junction cancer

  • 期刊论文

  • 发表日期：

    2025年1月17日

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  • Qingjiang Hu,
  • Manabu Ohashi,
  • Motonari Ri,
  • Rie Makuuchi,
  • Tomoyuki Irino,
  • Masaru Hayami,
  • Takeshi Sano,
  • Souya Nunobe

摘要

Background

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.

Methods

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 > 10 mm. The possible incidences of pathologically positive DM based on gross DM length were also calculated.

Results

Among 253 eligible patients, the maximum ΔDM was 55 mm. Growth and pathological types were significantly associated with ΔDM > 10 mm. In subgroup analyses, the maximum ΔDM was 30/20/55 mm for the superficial/expansive/infiltrative growth types, and 55/40 mm for the differentiated/undifferentiated types. In the infiltrative growth type alone, the maximum ΔDM remained 55/40 mm for the differentiated/undifferentiated types. However, even if the gross DM length was reduced to 30 mm, the possible incidence of pathologically positive DM only increased to 2.6% in the infiltrative differentiated type.

Conclusion

We recommend a minimum DM length of 30/20/55 mm for the superficial/expansive/ infiltrative growth types. Specifically in the infiltrative growth type, we alternatively recommend 30/40 mm 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.