
==== Front
Ann Surg Oncol
Ann Surg Oncol
Annals of Surgical Oncology
1068-9265
1534-4681
Springer International Publishing Cham

38987369
15779
10.1245/s10434-024-15779-8
ASO Author Reflections
ASO Author Reflections: The Prognostic Relevance of the Proximal Resection Margin Distance is Dependent upon the Histological Subtype of Gastric Adenocarcinoma
Rompen Ingmar F. MD 1
Schütte Isabel MD 1
Crnovrsanin Nerma MD 1
Schiefer Sabine MD 1
Billeter Adrian T. MD, PhD 12
Haag Georg Martin MD 3
Longerich Thomas MD 4
Czigany Zoltan MD 1
Schmidt Thomas MD 15
Billmann Franck MD 1
Sisic Leila MD 1
Nienhüser Henrik MD henrik.nienhueser@med.uni-heidelberg.de

1
1 grid.5253.1 0000 0001 0328 4908 Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
2 https://ror.org/04k51q396 grid.410567.1 0000 0001 1882 505X Department of Surgery, Clarunis-University Digestive Health Care Center, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
3 grid.5253.1 0000 0001 0328 4908 Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
4 grid.5253.1 0000 0001 0328 4908 Institute of Pathology Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
5 grid.411097.a 0000 0000 8852 305X Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
10 7 2024
10 7 2024
2024
31 10 69746975
25 6 2024
25 6 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by/4.0/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Universitätsklinikum Heidelberg (8914)Open Access funding enabled and organized by Projekt DEAL.

issue-copyright-statement© Society of Surgical Oncology 2024
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pmcPast

For distal gastric cancer, surgical resection can be performed by either distal gastrectomy or total gastrectomy.1 The ability to preserve the proximal stomach is limited by the proximal tumor extent with international guidelines, such as the ESMO guidelines, which recommend a proximal margin distance (PMD) of 3 cm for intestinal-type and 8 cm for diffuse-type cancers, adding an additional safety distance.2 However, the integration of the PMD into guidelines is based on correlations with fewer R1 resections; but meanwhile, with reliable intraoperative frozen section, the PMD may be omitted when feasible.3

Present

In the present analysis, intraoperative frozen section was found to be reliable, with less than 1% of cases having a positive proximal margin regardless.4 While in patients with intestinal-type tumors, oncological outcomes were not impaired when the minimum PMD was not retained, an adequate PMD was associated with improved disease-specific and overall survival in patients with cancers with noncohesive growth patterns (diffuse and mixed type).4 The results were comparable to those of stage II and III gastric cancer in a study by Squires et al., who, however, found a benefit of a 3 cm PMD only in stage I tumors and adjusted for diffuse histology in their multivariable analysis, but did not perform a separate analysis in that subgroup.5

Future

These results may inform intraoperative decision-making in the event that the recommended PMD is not achieved. In patients with intestinal-type tumors, a completion gastrectomy may be omitted without compromising oncological outcomes. Conversely, in patients with diffuse-type cancers, associations of an inadequate PMD with worse oncological outcomes suggest the need for additional margin clearance up to a total gastrectomy. Future research should validate these findings with multi-institutional data from centers with different practices of margin handling.

Funding

Open Access funding enabled and organized by Projekt DEAL. No funding was received for this project.

Disclosure

G.M.H. reports a consulting or advisory role for Bristol-Myers Squibb; MSD Sharp & Dohme, Lilly, Novartis, Daiichi Sankyo, Servier,Pierre Fabre, Astra Zeneca and Swiss Cancer League, honoraria for lectures or from Servier, MSD Sharp & Dohme, Lilly, Targos, Bristol-Myers Squibb, Astra Zeneca, and MCI Conventions, research funding by DKFZ Heidelberg and MSD Sharp & Dohme, and travel support/accommodations by Bristol-Myers Squibb Lilly Servier, MSD Sharp & Dohme, and Daiichi Sankyo. All other authors report no conflicts of interest.

This article refers to: Rompen IF, Schutte I, Crnovrsanin N, et al. Prognostic relevance of the proximal resection margin distance in distal gastrectomy for gastric adenocarcinoma. Ann Surg Oncol. (2024). 10.1245/s10434-024-15721-y.

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References

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Rompen IF, Schutte I, Crnovrsanin N, et al. Prognostic relevance of the proximal resection margin distance in distal gastrectomy for gastric adenocarcinoma. Ann Surg Oncol. 2024. 10.1245/s10434-024-15721-y.39283575
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