What Is the Impact of Positive Margins in the Liver?

2019 ◽  
pp. 113-117
Author(s):  
Ibrahim Nassour ◽  
Michael A. Choti
Keyword(s):  
Positive Margins ◽  
The Impact

Impact of Lymph Node Yield in Patients Undergoing Total Laryngectomy and Neck Dissection

2020 ◽  
pp. 000348942096482
Author(s):  
Michael C. Topf ◽  
Ramez Philips ◽  
Joseph Curry ◽  
Linda C. Magana ◽  
Madalina Tuluc ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Lymph Node ◽  
Neck Dissection ◽  
Total Laryngectomy ◽  
Single Institution ◽  
Level Of Evidence ◽  
Lymph Node Yield ◽  
Positive Margins ◽  
The Impact ◽  
Node Yield

Objectives: To determine the impact of lymph node yield (LNY) in patients undergoing neck dissection at the time of total laryngectomy (TL). To determine the impact of radiation therapy (RT) on LNY. Methods: Retrospective review of LNY and clinical outcomes in 232 patients undergoing primary or salvage total laryngectomy (TL) with ND. Results: Preoperative RT significantly decreased mean LNY from 31.7 to 23.9 nodes ( P < .001). In primary TL patients, age ( P < .001) and positive margins ( P = .044) were associated with decreased OS. In salvage TL patients, only positive margins was associated with poorer OS ( P = .009). No LNY cutoff provided significant OS or DFS benefit. Conclusions: Radiotherapy significantly reduces LNY in patients undergoing TL and ND. Within a single institution cohort, positive margins, but not LNY, is associated with survival in both primary and salvage TL patients. Level of Evidence: 4

The Impact of Positive Margins on Outcome Among Patients With Gastric Cancer Treated With Radiation

2016 ◽  
Vol 39 (3) ◽  
pp. 243-247 ◽  
Author(s):  
Jonathan D. Schoenfeld ◽  
Jennifer Y. Wo ◽  
Harvey J. Mamon ◽  
Eunice L. Kwak ◽  
John T. Mullen ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Positive Margins ◽  
The Impact

Selective benefit of adjuvant chemoradiation in resectable pancreatic cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4122-4122 ◽  
Author(s):  
Jesse P Wright ◽  
Cameron Schlegel ◽  
Rebecca A Snyder ◽  
Liping Du ◽  
Yu Shyr ◽  
...  
Keyword(s):  
Cox Regression ◽  
Margin Status ◽  
Resectable Pancreatic Cancer ◽  
Adjuvant Chemoradiation ◽  
Related Factors ◽  
Large Hospital ◽  
Positive Margins ◽  
Kaplan Meier ◽  
Independent Effects ◽  
The Impact

4122 Background: Although level 1 data supports the use of adjuvant chemotherapy (ACT) in resected pancreatic adenocarcinoma (PDAC), the role of adjuvant chemoradiation (ACRT) remains controversial. The objective of this study is to investigate the impact of adding ACRT to ACT on overall survival (OS), based on lymph node (LN) and margin status. Methods: Resected AJCC Stage I and II PDAC patients from 2004-2013 identified within the National Cancer Database were classified into groups based on treatment: surgery alone (SX), ACT alone, ACT+ACRT, and ACRT only. Kaplan-Meier analyses were performed to determine median OS. Multivariable (MV) Cox regression models with interactions of treatment with LN and margin status were constructed to examine the independent effects of ACT and ACT+ACRT in these subgroups. Results: Of 31,348 patients, 30% were treated with SX, 30% with ACT, 38% with ACT+ACRT, and 2% with ACRT alone. Median OS (mos.) for ACT (22.5, 95% CI 21.9-23.1) and ACT+ACRT (23.7, 23.3-24.2) were significantly longer than SX (14, 13.4-14.5) or ACRT (11.2, 9.8-12.9). MV analysis confirmed a significant OS benefit of both ACT and ACT+ACRT controlling for patient and tumor related factors. ACRT+ACT was associated with improved OS compared to ACT in patients with positive margins and/or LN. Those with negative margins and LN did not benefit from the additional use of ACRT (Table). Conclusions: This large hospital-based study demonstrates that ACT and ACRT are associated with improved OS when compared to SX. The addition of ACRT to ACT, however, was only beneficial in high-risk patients with positive margins and/or LN. ACT+ACRT in patients with both margin and LN negative disease may not be warranted. Future clinical trials should stratify patients based on LN and margin status in order to determine which patients are most likely to benefit from the use of ACRT. [Table: see text]

Impact of margin status on survival after radical nephrectomy for renal cell carcinoma (RCC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16084-e16084
Author(s):  
Lindsay Kaye Morris ◽  
Alaa Altahan ◽  
John Mays ◽  
Upama Giri ◽  
Eric Wiedower ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Tumor Size ◽  
Radical Nephrectomy ◽  
Margin Status ◽  
Significant Determinant ◽  
Positive Margins ◽  
Neoadjuvant Systemic Therapy ◽  
Significant Difference ◽  
Time To Relapse ◽  
The Impact

e16084 Background: Data is limited regarding outcomes in patients with RCC with positive surgical margins. We sought to evaluate the impact of margin status after radical nephrectomy (RN) on relapse free survival (RFS) and overall survival (OS). Methods: A retrospective study was conducted evaluating patients with RCC having undergone RN at Methodist University Hospital in Memphis, Tennessee, between January 2009 and December 2013. Patients were identified from the tumor registry at this institution, and IRB approval obtained. Patient and tumor characteristics and survival were analyzed by GraphPad Prism, Microsoft Excel and IBM SPSS. Results: 156 patients that underwent RN for RCC were identified; 12 patients (7.7%) had positive margins and 144 had negative margins. Mediation duration of follow-up was 3.4 years. 5 of 12 patients with positive margins relapsed, versus 20 of 144 with negative margins (41.7% v. 13.9%, p = 0.022) with a RR of 3.10 (95% CI 1.417-6.799). Among those who relapsed, there was a statistically significant difference in time to relapse between patients with positive and negative margins (mean number of days to relapse 275 versus 621, respectively, with p = 0.038). On multivariate analysis of age, gender, ethnicity, laterality, tumor histology, margin status, and tumor size, margin status was not a statistically significant determinant of OS at 1, 3, and 5 years (p = 0.051, 0.124 and 0.185 respectively) or RFS at 1, 3, and 5 years (p = 0.372, 0.271 and 0.242 respectively). Pearson correlation analysis showed significant correlation between tumor size and margin status, R = 0.478, p < 0.001. Conclusions: Positive margins were associated with earlier time to relapse among patients following RN. However, in multivariate analysis, margin status was not a statistically significant determinant of OS or RFS. In the current era of multiple available agents in RCC capable of cytoreduction, the risk factors that are predictive of a positive surgical margin at RN should be considered in the design of neoadjuvant systemic therapy trials, with the goal of improving long-term outcomes.

The impact of race on adverse pathologic features at the time of radical prostatectomy in men with prostate cancer and implications for adjuvant radiotherapy.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 75-75
Author(s):  
Gregory Arthur Jordan ◽  
Richa Bhasin ◽  
Alec Block ◽  
Alex Gorbonos ◽  
Marcus Lee Quek ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Black Men ◽  
Adjuvant Radiotherapy ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Positive Margins ◽  
Advanced Tumor ◽  
Pathologic Features ◽  
The Impact

75 Background: Patients with adverse pathologic features (≥pT3 disease or positive margins) at the time of radical prostatectomy (RP) have higher biochemical recurrence (BR). Adjuvant radiotherapy (ART) reduces BR, but has potential toxicities. Also, studies suggest Black men are more likely to have aggressive prostate cancer. Our objective was to identify whether black men undergoing RP are more likely to have adverse pathologic features (APF) that lead to an indication for ART. Methods: We conducted a retrospective cohort study of men with cT1-4 Nx/0 Mx/0 prostate adenocarcinoma in the National Cancer Database who underwent RP. Race was divided into 3 groups (Caucasian, Black, Other). Chi-square tests and analysis of variance (ANOVA) tests were used to compare clinical and socioeconomic covariates between race groups. Univariate (UVA) and multivariable analysis (MVA) were performed using logistic regression (LR) to identify covariates predicting for APF. LR was performed to identify the impact of race on pT3 disease and positive margins. Results: A total of 313,013 patients diagnosed between 2004-2014 and undergoing RP were included. 256,315 (85%) were Caucasian, 33,725 (11%) were Black, and 12,973 (4%) were Other race. Fewer Black men had Gleason group 1 (33% vs. 41%) but more had Gleason group 2 disease (46% vs. 38%, p < 0.001). Black men more frequently had PSA ≥10 ng/ml (18% vs. 16%, p < 0.001) and ≥cT2b disease (18% vs. 14%, p < 0.001). On UVA, Black men were more likely to have APF (Odds Ratio [OR] 1.18; 95% Confidence Interval [CI] 1.15-1.21; [p < 0.001]). On MVA, black race was independently associated with having APF (OR 1.21; 95% CI 1.18-1.24; p < 0.001). Black men were more likely to have positive margins (OR 1.26; 95% CI 1.22-1.29; p < 0.001) but less likely to have ≥pT3 disease (OR 0.77; 95% CI 0.74-0.79; p < 0.001). Conclusions: Independent of socioeconomic and clinical factors, Black men undergoing RP are more likely to have APF, increasing the risk of BR in this group, and more frequently creating an indication for ART. This appears to be more due to positive margins than locally advanced tumor. The underlying cause of this disparity warrants further exploration.

The Impact of Conversion to Laparotomy in Rectal Cancer

2020 ◽  
Vol 86 (7) ◽  
pp. 811-818
Author(s):  
Salvatore A. Parascandola ◽  
Salini Hota ◽  
Mayou Martin T. Tampo ◽  
Andrew D. Sparks ◽  
Vincent Obias
Keyword(s):  
Rectal Cancer ◽  
Minimally Invasive ◽  
Large Population ◽  
Oncologic Outcomes ◽  
Minimally Invasive Approach ◽  
Short Term ◽  
Population Database ◽  
Invasive Approach ◽  
Positive Margins ◽  
The Impact

Background Data regarding the effect of conversion from minimally invasive surgery (MIS) to laparotomy in rectal cancer is limited. This study examines the impact of conversion from laparoscopic or robotic-assisted techniques to open resection on oncologic outcomes in a large population database. Methods The National Cancer Database from 2010 to 2016 was reviewed for all cases of invasive adenocarcinoma of the rectum or rectosigmoid junction managed surgically. Patients were divided into 3 cohorts by approach: laparoscopic/robotic (MIS), converted proctectomy (CP), and open proctectomy (OP). Kaplan–Meier estimation was used for unadjusted survival analysis, followed by adjusted multivariable Cox-Proportional Hazards regression. Secondary outcomes were analyzed by multivariable logistic regression. Results The inclusion criteria identified 57 574 patients cases of adenocarcinoma of the rectum managed surgically. Of these patients, 23 579 (41.0%) underwent MIS, 3591 (6.2%) CP, and 30 404 (52.8%) OP. Five-year overall survival was greater in the MIS (70.4%) versus CP and OP (64.4% and 61.4%). No differences were detected for positive margins, 30-day, or 90-day mortality between CP and OP. MIS and CP approaches were significantly associated with increased odds of 12 or more regional lymph nodes examined and decreased overall mortality hazard compared with OP (all respective significant P < .05). Discussion While similar odds of positive margins and short-term mortality is seen in patients whose procedure converts to laparotomy compared with planned laparotomy, both short-term and long-term oncologic benefit is seen in those who undergo a minimally invasive approach. Thus, a minimally invasive approach should be attempted for patients with rectal cancer.

Bladder cancer patterns of pelvic failure: Implications for adjuvant radiation therapy.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 293-293
Author(s):  
Brian Christopher Baumann ◽  
Thomas J. Guzzo ◽  
Jiwei He ◽  
David J. Vaughn ◽  
Stephen Michael Keefe ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Margin Status ◽  
Adjuvant Radiation ◽  
Nodal Involvement ◽  
Node Dissection ◽  
Pattern Of Failure ◽  
Positive Margins ◽  
Target Volumes ◽  
Clinical Target Volumes ◽  
The Impact

293 Background: Local-regional recurrences (LF) after radical cystectomy with or without chemotherapy are common in patients with locally advanced disease. Adjuvant radiation (RT) could reduce LF, but toxicity discouraged its use. Modern RT with reduced morbidity has rekindled interest but requires knowledge of pelvic failure patterns to design appropriate clinical target volumes. Methods: 5-yr LF rates after radical cystectomy plus pelvic lymph node dissection with or without chemotherapy were determined for 8 pelvic sites among 442 patients with urothelial carcinoma of the bladder. The impact on the pattern of failure of pathologic stage, margin status, nodal involvement, and extent of node dissection was assessed using competing risk statistical methods. The percentage of patients whose sites of LF would be completely encompassed within various hypothetical clinical target volumes for post-operative radiation were calculated. Results: Stage pT3-4 patients had higher 5-yr LF rates in virtually all pelvic sites compared to pT0-2 patients. Among pT3-4 patients, margin status significantly altered the pattern of failure while extent of node dissection and pathologic nodal involvement did not. Stage pT3-4 patients with negative margins failed predominantly in the iliac/obturator nodes. Failures in the cystectomy bed and presacral region were significantly higher in pT3-4 patients with positive rather than negative margins. 76% of pT3-4 patients with negative margins who failed would have had all sites of LF included within clinical target volumes encompassing the iliac/obturator nodes, but only 57% of pT3-4 patients with positive margins would have their LF sites covered by such target volumes. Including the cystectomy bed and presacral region in the clinical target volume when margins were positive increased the percentage of encompassed failures to 91%. Conclusions: In adjuvant RT protocols, the obturator and iliac regions should be targeted in pT3-4 tumors with negative margins; coverage of presacral region and cystectomy bed is advised for pT3-4 with positive margins.

Impact of adjuvant therapies on survival in patients with cholangiocarcinoma.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 360-360
Author(s):  
Laura Dover ◽  
Rojymon Jacob ◽  
Thomas Wang ◽  
Robert Oster ◽  
Derek Dubay
Keyword(s):  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Surgical Resection ◽  
Cox Regression ◽  
Tumor Stage ◽  
Rank Test ◽  
Resection Margins ◽  
Positive Margins ◽  
Number Of Patients ◽  
The Impact

360 Background: Surgical resection is the only curative option for Cholangiocarcinoma (CC) and currently there are no clear guidelines for adjuvant therapy following resection. Given the high incidence of local and distant recurrences following resection, we evaluated the impact of adjuvant chemotherapy or chemoradiation (CRT) on median survival (OS). Methods: A retrospective review was performed identifying all patients with CC who underwent curative surgical resection at our institution between 2002 and 2012. Patients who underwent aborted or palliative procedures were excluded. Survival estimates were quantified using Kaplan Meier curves, and differences between groups were compared with the log-rank test and Cox regression models. Results: During the study period, 103 patients underwent curative resection for CC at our institution. Tumor location was intrahepatic, perihilar and distal in 37% (n=38), 23% (n=24) and 40% (n=41) respectively. A total of 49 (48%) patients received adjuvant chemotherapy (n= 28) or CRT (n=21). Observation with no additional therapy was employed in the remaining 54 (52%) patients. No patient was treated using radiation alone. OS was 21.4 and 41.4 months (m) for those receiving adjuvant therapy versus observation (p=0.08). OS for adjuvant therapy versus observation were 28.4 m and 19.4 m respectively, if surgical margins were positive (p=0.036); and 79.1 m and 26.3 m respectively (p=0.4) with negative resection margins. OS was 41.4 m and 38.0 m with adjuvant chemo versus CRT respectively (p=0.1). Tumor stage was the only statistically significant pathologic indicator of outcome (p=0.019). Conclusions: A trend towards significant improvement in OS was observed with the use of adjuvant therapy among all patients following resection of CC. Adjuvant therapy significantly improved OS among CC patients with positive margins of resection. The small number of patients with negative margins of resection also benefitted, though not significantly. These data suggest that while adjuvant therapy should be considered for all patients irrespective of margin status; patients with positive margins are likely to benefit the most.

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