# Real-World Experience of Clinical Outcomes of Microscopic Margin Positivity After Radical Gastrectomy from a Tertiary Cancer Center in Northeast India

## TL;DR

This study examines the clinical outcomes of patients with positive surgical margins after gastric cancer surgery in Northeast India, finding poor survival rates.

## Contribution

The study provides real-world data on the prognosis of gastric cancer patients with microscopic margin positivity in a specific geographic region.

## Key findings

- 13 out of 172 patients had microscopic positive margins after gastrectomy.
- Median overall survival for these patients was 20.2 months.
- Most patients with positive margins had poorly differentiated or signet-ring cell carcinoma.

## Abstract

Surgical resection for gastric adenocarcinoma (GAC) remains the only potentially curative treatment, and the use of neoadjuvant and adjuvant therapy improves survival in patients with advanced gastric cancer. Margin-positive resection is a known poor prognostic factor. A retrospective observational study of patients undergoing radical gastrectomy of any type for GAC was done at a tertiary care cancer center in Northeast India. The study included patients who were operated on from 1 January 2017 to 31 December 2021 (5 years), and they were followed up to 31 March 2024. A total of 172 patients underwent gastrectomy of any type for GAC during the study period of which 13 patients were found to have microscopic positive (R1) histopathological margin (7.6%). The median age of the patients with positive margins was 48 years (range 27 to 69 years). The male-to-female ratio was 9:4. Ten patients (77%) had poorly differentiated or signet-ring cell carcinoma. The distal margin was the most frequent margin which was positive (84.6%). Neoadjuvant chemotherapy was used in only 23.1% patients. At the end of our study period, only 1 patient out of 13 patients was alive. Median disease-free survival (DFS) was 16.2 months (95% confidence interval 1.2 to 31.1 months). Median overall survival (OS) was 20.2 months (95% confidence interval 9.3 to 31.2 months). Patients who have microscopic positive margins after gastrectomy are found to have a high incidence of poorly differentiated or signet-ring cell carcinoma.