Management of the Positive Proximal Margin during Total Gastrectomy: Dose Re-Excision Benefit all the Time? Findings of a Small-Sample Retrospective Study

Background and Objectives: Positive proximal margin during total gastrectomy suggest noncurative resection, but benefits and risks of extended resection remains controversial. We aim to assess the necessity of re-excision intraoperatively in case of a positive proximal margin. Methods: 1,115 consecutive gastric cancer patients undergoing total gastrectomy were reviewed retrospectively between August 2014 and March 2017. Thirty-four patients with positive proximal margins were divided into two groups according to whether intraoperative re-excision was performed. The clinicopathologic and prognostic data were analyzed. Results: Sixteen patients (52.9%) with intraoperative re-excision belonged to re-excision group. There was no significant difference regarding to overall morbidity, mortality and length of stay in hospital between groups. But more frequent occurrence of anastomotic leakage was found in re-excision group (p=0.016). Higher position of anastomosis was found in re-excision group and associated with more anastomotic leakage. Overall survival and progression free survival showed no difference after a short follow-up between groups, although patients in re-excision group had more R0 resections. Conclusion: During total gastrectomy when negative margin was not achieved at the first attempt, extended resection might result in higher risk of anastomotic leakage instead of better prognosis due to advanced tumor stage.