Surgical Management of Microscopic Positive Resection Margin After Gastrectomy for Gastric Cancer: A Systematic Review of Gastric R1 Management

Background: The prognosis after a curative resection for gastric cancer is modified by the lymph node involvement, while the prognostic significance of a microscopically-positive resection margin is debated. We systematically reviewed the literature from 1998 to 2013 to describe the role of surgery in the management of gastric cancer with a R1 after gastrectomy. Materials and Methods: The research was systematically performed on Pubmed, EMbase, Cochrane Library, CILEA Archive, BMJ Clinical Evidence and Up ToDate databases. Twelve studies were included in this review, for a total of 15,008 patients. Results: The results reported in literature are inconsistent and the impact of surgical and oncological therapies is unknown. Intraoperative frozen sections should be performed to achieve a negative margin with intraoperative re-excision. Conclusion: A surgical re-excision of an R1 resection should be considered for patients with fewer than three disease-positive nodes because survival is more likely to be governed by positive margins than by nodal status.