尽管日本指南建议晚期胃癌 (GC) 的手术切缘距离为 3-5 厘米，但人们对手术切缘的临床效果知之甚少，尤其是远端切除切缘 (DM)。本研究旨在阐明DM在GC中的临床意义。对2008年至2018年间415例接受根治性远端胃切除术的GC患者进行回顾性分析。DM无复发生存率显着分层（P = 0.002），DM < 30 mm是预后不良的独立因素（P = 0.023，风险比：1.91）。 DM < 30 mm 组的淋巴复发发生率显着高于 DM ≥ 30 mm 组（P = 0.019，6.9% vs. 1.9%）。晚期GC中6号站淋巴结转移（DM < 30 mm vs. 30 mm ≤ DM ≤ 50 mm vs. DM > 50 mm），数量（P < 0.001、1.42 ± 1.69 vs. 1.18 ± 1.80）与0.18±0.64），DM < 30 mm组的阳性率（P < 0.001，59.0% vs. 46.7% vs. 11.3%）和治疗价值指数（43.3 vs. 14.5 vs. 8.0）显着较高。通过使用 30 mm 的 DM 距离进行细分，可以进行更分段的预后分层 (P < 0.001)。小于 30 mm 的 DM 可能是 RFS 较差的替代标志，尤其是增加淋巴结复发。对于这种情况的患者需要更强化的治疗策略，包括淋巴结切除术和化疗。© 2023。作者。

Although a 3-5 cm surgical margin distance is recommended for advanced gastric cancer (GC) in Japanese guidelines, little is known about the clinical effects of the surgical margin, especially the distal resection margin (DM). This study aims to clarify the clinical significance of DM in GC.A total of 415 GC patients who underwent curative distal gastrectomy between 2008 and 2018 were analyzed retrospectively.The DM significantly stratified recurrence-free survival (P = 0.002), and a DM < 30 mm was an independent factor of a poor prognosis (P = 0.023, hazard ratio: 1.91). Lymphatic recurrence occurred significantly more frequently in the DM < 30 mm group than in the DM ≥ 30 mm group (P = 0.019, 6.9% vs. 1.9%). Regarding the station No.6 lymph node metastases in advanced GC (DM < 30 mm vs. 30 mm ≤ DM ≤ 50 mm vs. DM > 50 mm), the number (P < 0.001, 1.42 ± 1.69 vs. 1.18 ± 1.80 vs. 0.18 ± 0.64), the positive rate (P < 0.001, 59.0% vs. 46.7% vs. 11.3%) and therapeutic value index (43.3 vs. 14.5 vs. 8.0) were significantly higher in the DM < 30 mm group. By subdivision using the DM distance of 30 mm, more segmented prognostic stratifications were possible (P < 0.001).A DM of less than 30 mm could be a surrogate marker of poor RFS, especially increasing nodal recurrence. More intensive treatment strategies, including lymphadenectomy and chemotherapy, are needed for patients with this condition.© 2023. The Author(s).