Surgical safety margin of gastroenterological cancer surgery: A truth or a dream?

SummaryMost surgeons dream about performing an extensive resection with a wide resection margin and extensive lymph nodes dissection, which will yield a favorable prognosis. Previous studies have reported varying lengths of the margins based on different clinical profiles. The so-called safety margin is not completely safe because limited scientific evidence exists for nonrecurrence, even after the patient has had a pathological examination to prove a negative cancer invasion at the resection margin. The safety margins for malignancy are different in the esophagus, stomach, colorectum, liver, and others because of the different modes of carcinogenesis and variable paths of recurrence. However, a minimally acceptable margin length can be defined because the margin is destroyed during operative dissection or shortened after formalin fixation for tissue assessment during pathological diagnosis. The currently available data for supporting the reality of a true negative or true positive invasion at the resection margin could be presumed by gross findings of a solid tumor. A safety margin for esophageal, gastric, liver, and colorectal cancer could be 0.1, 2–4, 2, and 1–3 cm, respectively. A dream to have a real safety surgical margin to achieve better surgical outcome is a challenge for any gastroenterological surgeon. However, a complete safety margin may not always be realized because it is impossible to have a true negative margin from surgical equipment and pathological tissue process.