Improving the quality of gastric cancer surgery: factors associated with positive resection margins for gastrectomy

Purpose Positive margins after gastrectomy have been associated with poor patient prognosis. This study aimed to identify risk factors associated with margin-positive resections. Methods The National Cancer Database was queried from 2004 to 2014 for all patients with gastric adenocarcinoma who underwent resection with curative intent and had known margin status. Univariable and multivariable logistic regression analysis was performed to identify variables associated with positive margins. Results A total of 32,193 patients were identified who met study inclusion criteria, of which 11.8% (3786 patients) had a margin-positive resection. Tumor size > 6 cm, T3 or T4 tumors, tumor location in the body of stomach or in multiple regions, signet ring cell histology, presence of lymphovascular invasion, positive lymph node involvement, and lack of neoadjuvant therapy were independently associated with an increased risk of positive margins. Conclusions Advanced disease characteristics, aggressive tumor pathology, and absence of neoadjuvant therapy were associated with margin-positive resections.