根治性手术可以降低远端胃癌患者的复发风险。然而，对于建议的最小近端边缘距离（PMD）的值存在争议。在这里，我们评估近端切除边缘与肿瘤之间的安全距离的预后价值。这是一项针对胃腺癌接受远端胃切除术的患者的单中心队列研究（2001-2021）。根据欧洲肿瘤内科学会 (ESMO) 指南，队列根据 PMD 的充分性进行定义（肠道≥5 cm，弥漫性 Lauren 亚型≥8 cm）。通过对数秩和多变量 Cox 回归分析评估总生存期 (OS) 和进展时间 (TTP)。在 176 名患者中，70 名 (39.8%) 具有足够的 PMD。足够的 PMD 与肠道亚型癌症相关（67% vs. 45%，p = 0.010）。 PMD 充足和不足的估计 5 年生存率分别为 63% [95% 置信区间 (CI) 51-78] 和 62% (95% CI 53-73)。总体而言，在多变量分析中，足够的 PMD 并不能预测 OS（HR 0.81，95% CI 0.48-1.38）。然而，在弥漫性亚型患者中，足够的 PMD 与改善肿瘤结果相关（未达到中位 OS 与 131 个月相比，p = 0.038，未达到中位 TTP 与 88.0 个月相比，p = 0.003）。弥漫性胃癌患者处于PMD 不足时进行切除的风险更大，这对于这些患者来说与较差的肿瘤结果相关。对于肠道亚型，与 PMD 没有预后相关性，这表明在无法实现广泛 PMD 的情况下，部分保留胃功能的远端胃切除术也可能是可行的。© 2024。作者。

The risk for recurrence in patients with distal gastric cancer can be reduced by surgical radicality. However, dispute exists about the value of the proposed minimum proximal margin distance (PMD). Here, we assess the prognostic value of the safety distance between the proximal resection margin and the tumor.This is a single-center cohort study of patients undergoing distal gastrectomy for gastric adenocarcinoma (2001-2021). Cohorts were defined by adequacy of the PMD according to the European Society for Medical Oncology (ESMO) guidelines (≥ 5 cm for intestinal and ≥ 8 cm for diffuse Laurén's subtypes). Overall survival (OS) and time to progression (TTP) were assessed by log-rank and multivariable Cox-regression analyses.Of 176 patients, 70 (39.8%) had a sufficient PMD. An adequate PMD was associated with cancer of the intestinal subtype (67% vs. 45%, p = 0.010). Estimated 5-year survival was 63% [95% confidence interval (CI) 51-78] and 62% (95% CI 53-73) for adequate and inadequate PMD, respectively. Overall, an adequate PMD was not prognostic for OS (HR 0.81, 95% CI 0.48-1.38) in the multivariable analysis. However, in patients with diffuse subtype, an adequate PMD was associated with improved oncological outcomes (median OS not reached versus 131 months, p = 0.038, median TTP not reached versus 88.0 months, p = 0.003).Patients with diffuse gastric cancer are at greater risk to undergo resection with an inadequate PMD, which in those patients is associated with worse oncological outcomes. For the intestinal subtype, there was no prognostic association with PMD, indicating that a distal gastrectomy with partial preservation of the gastric function may also be feasible in the setting where an extensive PMD is not achievable.© 2024. The Author(s).