ReviewAnnals of surgical oncology2026
Positive Intraoperative Frozen Section during Surgery for Junctional and Gastric Cancer: Should We Re-Resect? A Systematic Review and Meta-Analysis.
Review in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIntraoperative frozen section analysis is used during surgery for esophagogastric adenocarcinoma to achieve radical (R0) resection, but the prognostic impact of conversion to R0 remains debated. A meta-analysis evaluating whether re-excision after a positive frozen section improves overall survival is currently lacking.
methodsWe conducted a systematic review of PubMed, Embase, and Web of Science (from inception to February 2025) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included ≥ 25 patients with esophageal, junctional, or gastric adenocarcinoma undergoing curative-intent surgery. The primary outcome was overall survival in R0-converted versus R1 resection patients. Hazard ratios with 95% confidence intervals were used as outcome measures. A random-effects meta-analysis was performed, and risk of bias was assessed using the ROBINS-I tool.
resultsSix retrospective studies including 2082 patients were analyzed. Most had gastric (62.5%, n=1301) or junctional (33.6%, n=700) adenocarcinoma. Gastrectomy was performed in 82.5% of patients, including total gastrectomy in 36.3%. Overall, 385 patients had a positive intraoperative frozen section; re-excision was attempted in 63.4% (n=244), and successful R0 conversion was achieved in 83% (n=203). R0-converted patients more frequently underwent total gastrectomy than R1 patients (65.4% vs. 46.1%). Although the primary analysis showed no significant survival difference, sensitivity analysis excluding one influential study demonstrated a survival benefit for R0-converted patients (hazard ratio 0.72; 95% confidence interval 0.60-0.85).
conclusionIntraoperative frozen section-guided margin clearance improves survival in esophagogastric adenocarcinoma surgery. However, evidence is largely driven by patients with gastric cancer converting from subtotal to total gastrectomy as data on esophageal margin revision after total gastrectomy are limited.
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