Margins of resection of the esophagus for gastric cancer with esophageal invasion

Background/Aims: We retrospectively examined the rate of infiltration of proximal margins of resection in patients resected for gastric cancer with esophageal invasion. Material and Methods: In the 175 proximal margins examined, the incidence was related to the gross appearance, histologic type, size, depth of invasion, shape of the oral edge, length of grossly tumor-free edge and Length of histologic esophageal invasion. Results: Multivariate analysis indicated that undifferentiated adenocarcinoma and length of histologic esophageal invasion are significant risk factors for positive margin. Infiltration occurred in 13.7% (24 cases) of the oral margins of transection. Eight patients were potentially curative other than positive margin and 5 were caused by underestimation of the distance of oral margin. With reference to the length of margin of resection, no involvement was found when the cranial distance between the Lesion and the line of transection exceeded 2 cm in patients with orally well-defined type esophageal invasion. In patients with the orally ill-defined type, transection with a distance greater than 4 cm commonly guarantee safety of the proximal margin, except for cases with lymphatic invasion. Conclusions: These data provide the surgeon with a rational basis for assessing the extent of resection when performing esophagectomy combined with gastrectomy for cancer.