Outcome of failure in clearing the oesophageal margin in total gastrectomy for adenocarcinoma
Goh, H.S.; Wong, T.H.; Ti, T.K.; Rauff, A.
Annals of the Academy of Medicine Singapore 18(1): 69-71
1989
ISSN/ISBN: 0304-4602 PMID: 2712522 Document Number: 344822
Failure to clear the oesophageal margin in total gastrectomy for adenocarcinoma is believed to be a major cause of mortality and morbidity. The incidence of histologically positive margin could range from 7.3 to 74%. Forty nine cases of total gastrectomy for adenocarcinoma were reviewed and nine (18%) had a positive oesophageal margin. One of the nine patients died on the second postoperative day from technical difficulty: the rest did not have anastomotic leaks. They all eventually died of metastatic disease in 3-20 months. Two had mild dysphagic symptoms which did not require active intervention. It is concluded that a histologically positive oesophageal margin in total gastrectomy does not preclude good anastomotic healing. Sound surgical judgement is required to balance the risk of leaving a positive margin and the risk of an extended operative procedure particularly when majority of the total gastrectomies are palliative rather than curative.