Positive Intraoperative Frozen Section during Surgery for Junctional and Gastric Cancer: Should We Re-Resect? A Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and random-effects meta-analysis assessed whether re-excision after a positive intraoperative frozen section is associated with improved overall survival in patients undergoing curative-intent surgery for esophageal, junctional, or gastric adenocarcinoma. Six retrospective studies included 2082 patients; 385 had a positive frozen section, and 203 achieved R0 conversion. The primary analysis found no significant survival difference between R0-converted and R1 patients. In a sensitivity analysis excluding one influential study, R0 conversion was associated with better survival (hazard ratio 0.72; 95% confidence interval 0.60-0.85).

Key findings

• Among 385 patients with a positive frozen section, re-excision was attempted in 63.4% (n=244), with R0 conversion achieved in 83% (n=203).
• The primary analysis found no significant overall-survival difference between R0-converted and R1 patients.
• After excluding one influential study, R0 conversion was associated with improved survival (hazard ratio 0.72; 95% confidence interval 0.60-0.85).
• R0-converted patients more often underwent total gastrectomy than R1 patients (65.4% vs. 46.1%).

Why it matters

The findings address whether additional resection after a positive intraoperative margin may be worthwhile, while showing that the survival signal is sensitive to the studies included. The evidence may inform discussion of margin clearance, but its applicability is strongest for gastric cancer and should not be assumed to extend equally to esophageal margin revision.

What to keep in mind

Evidence came from six retrospective studies, and the primary analysis showed no significant survival difference. The sensitivity result depended on excluding one influential study; evidence on esophageal margin revision after total gastrectomy was limited.