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Mide Karsinomalı Hastalarda Mikroskopik Rezeksiyon Sınırı Tutulumunun Prognostik Önemi

Prognostic significance of microscopic resection margin involvement in patients with gastric carcinoma

Journal Name:

  • Cerrahpaşa Tıp Dergisi

Publication Year:

  • 2009

Key Words:

Keywords (Original Language):

Author Name
Abstract (2. Language): 
Objectives: It is controversial whether reresection subsequent to gastrectomy is beneficial in gastric carcinoma patients with confirmed microscopic resection margin involvement. In this study, the prognostic significance of microscopic tumor involvement in resection margin in various subgroups of patients with gastric carcinoma was investigated. Methods: Three hundred and thirty-one gastric carcinoma patients who were supposed to be resected curatively were included in the study; data was collected prospectively. When postoperative histologic examination revealed tumor in the resection margins, it was termed as margin positive. Margin positive and negative patients were compared with regard to histopathologic features, mortality and overall survival. Thirty patients who died of complications were not included in survival analysis. Results: Tumor involvement in the resection margin was found in 47 (14.2%) patients. Margin positivity rates were significantly higher in tumors over 6 cm in size, in undifferentiated tumors, in tumors with vascular and perineural invasion. Early mortality rates did not differ significantly between patients with positive margin and with negative margin ( 5/47, 10.6% and 25/284, 8.8%, respectively). Considering the whole series, overall 5-year survival was 2.4% in patients with margin involvement and 32.8% in patients without margin involvement (p<0.0001). In the multivariate Cox analysis margin involvement had independent prognostic significance (p<0.001). The survival of margin positive patients was poorer than margin negative patients in both node negative (p=0.0087) and node positive (p<0.0001) groups. Margin involvement had prognostic value in subgroup with the ratio of metastatic lymph nodes to removed lymph nodes was <0.50 (p<0.0001); however margin involvement had not prognostic importance in subgroup with ratio ≥0.50. Conclusion: In patients with negative lymph nodes and metastatic lymph node ratio of less than 0.50, when microscopic margin involvement is encountered postoperatively, reresection to provide negative surgical margins should be considered in suitable patients.
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Abstract (Original Language): 
Amaç: Gastrektomi sonrasında mikroskopik sınır tutulumu saptanan mide karsinomalı hastalarda rerezeksiyonun yararlı olup olmadığı tartışmalıdır. Bu çalışmada mide karsinomalı hastaların değişik altgruplarında, rezeksiyon sınırında mikroskopik tümör tutulumunun prognostik önemi incelendi. Yöntem: Potansiyel olarak küratif rezeksiyon yapıldığı düşünülen mide karsinomalı 331 hasta çalışmaya alındı; veriler prospektif olarak topland›. Ameliyat sonrası yapılan histopatolojik incelemede rezeksiyon sınırlarında tümör görüldüğünde sınır pozitif olarak adlandırıldı. Sınır pozitif ve negatif hastalar klinikopatolojik özellikler, mortalite ve genel sağkalım açısından karşılaştırıldı. Komplikasyonlar nedeniyle ölen 30 hasta sağkalım analizine alınmadı. Bulgular: 47 (%14.2) hastada rezeksiyon sınırında tümör tutulumu vardı. 6 cm’den büyük, andiferansiye, vasküler ve perinöral invazyonu olan tümörlerde sınır pozitifliği anlamlı olarak daha yüksek oranda idi. Sınır tutulumu olan ve olmayan hastaların erken mortalite oranları (sırasıyla 5/47, %10.6 ve 25/284 , %8.8) arasında anlamlı fark yoktu. Tüm seri için, 5-yıllık genel sağkalım sınır tutulumu olan hastalarda % 2.4, olmayanlarda % 32.8 idi (p<0.0001). Çok değişkenli Cox analizinde sınır tutulumu bağımsız prognostik öneme sahipti (p<0.001). Hem lenf düğümü negatif (p=0.0087) hem de lenf düğümü pozitif (p<0.0001) hasta grubunda sınır pozitif olanların sağkalımı negatif olanlardan anlamlı olarak daha kötü idi. Metastazlı lenf düğümlerinin sayısının çıkarılan lenf düğümlerinin sayısına oranı <0.50 olan altgrupta sınır tutulumu prognostik değere sahipken (p<0.0001), bu oranın ≥0.50 olduğu altgrupda sınır tutulumunun prognostik önemi yoktu. Sonuç: Lenf düğümü negatif ve metastazlı lenf düğümlerinin oranı 0.50’den düşük olan hastalarda, ameliyat sonrası incelemede mikroskopik sınır tutulumu saptandığında, durumu uygun olan hastalarda sınır negatifliğini sağlayacak rerezeksiyon yapılması düşünülmelidir.
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  • Turkish

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Süre (ay)
Genel Sa¤kal›m Oran›
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