103 Positive Proximal Resection Margin Following Subtotal Gastrectomy: Is There a Role for Completion Gastrectomy?

Abstract Aim To assess the incidence of positive proximal resection margin following subtotal gastrectomy for gastric adenocarcinoma and evaluate the role of completion gastrectomy (CG). Method A retrospective review was conducted of patients undergoing subtotal gastrectomy for gastric adenocarcinoma at a single center between 2007 and 2025. Pathology reports were examined to identify those with positive longitudinal resection margins. Cases with an isolated positive proximal margin were assessed for eligibility and outcomes following completion gastrectomy. Results Of the 192 patients who underwent subtotal gastrectomy, 15 (7.8%) were found to have a positive longitudinal resection margin. Among these, 9 patients (4.7%) had a positive distal margin, 3 patients (1.6%) had both positive proximal and distal margins, and 3 patients (1.6%) had an isolated positive proximal margin. These three patients were considered for completion gastrectomy. The first patient underwent successful completion gastrectomy for ypT1N0 moderately differentiated adenocarcinoma and remains disease-free more than 15 years postoperatively. The second patient was taken for exploratory laparotomy six weeks after the initial surgery with the intention of performing completion gastrectomy but was found to have extensive peritoneal metastases; a defunctioning loop ileostomy was performed instead. The third patient had advanced cancer (pT3N1 with lymphovascular invasion), significant comorbidities, and was managed with adjuvant chemotherapy rather than surgery, achieving a survival of 24 months. Conclusions An isolated positive proximal resection margin is an uncommon finding following subtotal gastrectomy for gastric adenocarcinoma. Completion gastrectomy may be considered a curative option, but only in carefully selected patients.