Intraoperative frozen section margin evaluation in gastric cancer of the cardia surgery

Background/Aims: The use of intraoperative frozen section to determine the extent of margin resection is a common practice. Our aim was to identify the value of intraoperative frozen section in margin evaluation and to investigate its indication for gastric cancer of the cardia. Methodology: Intraoperative frozen section examinations of the proximal margins of 66 patients with gastric adenocarcinoma of the cardia were reviewed. The frozen section results were compared with those of the permanent sections. Clinicopathological features that predict a positive frozen section margin were examined by univariate and multivariate analysis. Results: The overall accuracy, sensitivity and specificity of an intraoperative frozen section, was 97%, 77.8%, and 100%, respectively. Infiltration on frozen section occurred in 10.7% (7/66) of the proximal margins, while in 28.6% (2/7) of the entire additional resection margins. The positive margins were associated with more advanced in depth of tumor invasion and disease stage. However, the depth of invasion was the only independent predictor for a positive frozen margin. Conclusions: Routine evaluation of the proximal resection margin by intraoperative frozen section does not appear to be necessary in gastric cancer surgery of the cardia. However, this technique is advisable for patients with T3 or T4 lesions.