Resection margin strategy in gastric cancer surgery: the European REMARCS (Resection MARgin for Cancer of the Stomach) survey

Abstract Background Surgery with negative resection margins and appropriate lymphadenectomy is the only curative treatment for gastric cancer. The adequate proximal resection margins length in European guidelines is between 5 to 8 centimeters depending on the histological subtype. However, these recommendations are based on outdated studies with limited data. The peri-operative treatment modalities have evolved, and the application of these resection margin cut-offs may not be as uniform as before. The aim of our study was to assess the current European practice in gastric cancer surgery with particular attention to resection margins. Methods A panel of 13 international experts composed of surgeons, pathologists, and oncologists developed a web-based survey containing 45 questions about center demographic, resection margin strategy, and post-operative care. The survey was distributed to Upper Gastrointestinal (UGI) surgeons through UGI and visceral surgical societies mailing lists and social media between February and June 2022. Participants were excluded if they did not answer a minimum of 80% completion of the questionary). Results 172 surgeons from 154 centers in 19 countries responded to the survey. The most represented countries were Germany 60 (35%), Switzerland 30 (18%) and Italy 16 (9%). The mean surgical years’ experience of the responders was 20.8 and their caseload was 23.2 cases per year. For intestinal type gastric tumor, a proximal resection margin length of a minimum of 5 centimeters was advocated by 119 (77%) of the responders. For diffuse, a resection margin of a minimum of 8 cm was applied by 98 (63%) of the surgeons. Macroscopic inspection of the specimen was routinely performed by 110 respondents (64%). Conclusions The real-world data from our questionnaire shows that the length of resection margins proposed by actual guidelines are not strictly applied in European centers. Further data from clinical research are needed to standardize resection margin cut-off. This could help European surgeons to propose more organ-sparing strategies to their patients.