Detecting tumour-positive resection margins after oral cancer surgery by spraying a fluorescent tracer activated by gamma-glutamyltranspeptidase

IntroductionAchieving adequate resection margins during oral cancer surgery is important to improve patient prognosis. Surgeons have the delicate task of achieving an adequate resection and safeguarding satisfactory remaining function and acceptable physical appearance, while relying on visual inspection, palpation, and preoperative imaging. Intraoperative assessment of resection margins (IOARM) is a multidisciplinary effort, which can guide towards adequate resections. Different forms of IOARM are currently used, but it is unknown how accurate these methods are in predicting margin status. Therefore, this review aims to investigate: 1) the IOARM methods currently used during oral cancer surgery, 2) their performance, and 3) their clinical relevance.MethodsA literature search was performed in the following databases: Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar (from inception to January 23, 2020). IOARM performance was assessed in terms of accuracy, sensitivity, and specificity in predicting margin status, and the reduction of inadequate margins. Clinical relevance (i.e., overall survival, local recurrence, regional recurrence, local recurrence-free survival, disease-specific survival, adjuvant therapy) was recorded if available.ResultsEighteen studies were included in the review, of which 10 for soft tissue and 8 for bone. For soft tissue, defect-driven IOARM-studies showed the average accuracy, sensitivity, and specificity of 90.9%, 47.6%, and 84.4%, and specimen-driven IOARM-studies showed, 91.5%, 68.4%, and 96.7%, respectively. For bone, specimen-driven IOARM-studies performed better than defect-driven, with an average accuracy, sensitivity, and specificity of 96.6%, 81.8%, and 98%, respectively. For both, soft tissue and bone, IOARM positively impacts patient outcome.ConclusionIOARM improves margin-status, especially the specimen-driven IOARM has higher performance compared to defect-driven IOARM. However, this conclusion is limited by the low number of studies reporting performance results for defect-driven IOARM. The current methods suffer from inherent disadvantages, namely their subjective character and the fact that only a small part of the resection surface can be assessed in a short time span, causing sampling errors. Therefore, a solution should be sought in the field of objective techniques that can rapidly assess the whole resection surface.

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Intra-operative assessment of tumor resection margins by Raman spectroscopy to guide oral cancer surgery (Conference Presentation)

Biomedical Vibrational Spectroscopy 2020: Advances in Research and Industry ◽

10.1117/12.2544394 ◽

2020 ◽

Author(s):

Gerwin J. Puppels ◽

Elisa M. L. Barroso ◽

Yassine Aaboubout ◽

Maria Rosa Nunes Soares ◽

Viacheslav G. Artyushenko ◽

...

Keyword(s):

Raman Spectroscopy ◽

Oral Cancer ◽

Tumor Resection ◽

Cancer Surgery ◽

Resection Margins ◽

Operative Assessment

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The Predictors and Clinical Impact of Positive Resection Margins on Frozen Section in Gastric Cancer Surgery

Journal of Gastric Cancer ◽

10.5230/jgc.2012.12.2.113 ◽

2012 ◽

Vol 12 (2) ◽

pp. 113 ◽

Cited By ~ 15

Author(s):

Se Yeong Kim ◽

Yoon Sun Hwang ◽

Tae Sung Sohn ◽

Seung Jong Oh ◽

Min Gew Choi ◽

...

Keyword(s):

Gastric Cancer ◽

Frozen Section ◽

Clinical Impact ◽

Cancer Surgery ◽

Resection Margins ◽

Gastric Cancer Surgery ◽

Positive Resection Margins

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Resection margins in oral cancer surgery: Room for improvement

Head & Neck ◽

10.1002/hed.24075 ◽

2015 ◽

Vol 38 (S1) ◽

pp. E2197-E2203 ◽

Cited By ~ 57

Author(s):

Roeland W.H. Smits ◽

Senada Koljenović ◽

Jose A. Hardillo ◽

Ivo ten Hove ◽

Cees A. Meeuwis ◽

...

Keyword(s):

Oral Cancer ◽

Cancer Surgery ◽

Resection Margins

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Radiation-Associated Angiosarcoma of the Breast and Chest Wall Treated with Thermography-Controlled, Contactless wIRA-Hyperthermia and Hypofractionated Re-Irradiation

Cancers ◽

10.3390/cancers13153911 ◽

2021 ◽

Vol 13 (15) ◽

pp. 3911

Author(s):

Markus Notter ◽

Emanuel Stutz ◽

Andreas R. Thomsen ◽

Peter Vaupel

Keyword(s):

Local Recurrence ◽

Background Radiation ◽

Definitive Treatment ◽

Resection Margins ◽

Recurrence Rates ◽

Rate Dependent ◽

Angiosarcoma Of The Breast ◽

Positive Resection Margins ◽

Locally Recurrent ◽

Tumor Extent

Background: Radiation-associated angiosarcoma of the breast (RAASB) is a rare, challenging disease, with surgery being the accepted basic therapeutic approach. In contrast, the role of adjuvant and systemic therapies is a subject of some controversy. Local recurrence rates reported in the literature are mostly heterogeneous and are highly dependent on the extent of surgery. In cases of locally recurrent or unresectable RAASB, prognosis is very poor. Methods: We retrospectively report on 10 consecutive RAASB patients, most of them presenting with locally recurrent or unresectable RAASB, which were treated with thermography-controlled water-filtered infrared-A (wIRA) superficial hyperthermia (HT) immediately followed by re-irradiation (re-RT). Patients with RAASB were graded based on their tumor extent before onset of radiotherapy (RT). Results: We recorded a local control (LC) rate dependent on tumor extent ranging from a high LC rate of 100% (two of two patients) in the adjuvant setting with an R0 or R2 resection to a limited LC rate of 33% (one of three patients) in patients with inoperable, macroscopic tumor lesions. Conclusion: Combined HT and re-RT should be considered as an option (a) for adjuvant treatment of RAASB, especially in cases with positive resection margins and after surgery of local recurrence (LR), and (b) for definitive treatment of unresectable RAASB.

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Predicting Surgical Margins in Patients With Borderline Resectable and Locally Advanced Pancreatic Cancer Undergoing Resection

The American Surgeon ◽

10.1177/00031348211011129 ◽

2021 ◽

pp. 000313482110111

Author(s):

Weizheng Ren ◽

Dimitrios Xourafas ◽

Stanley W. Ashley ◽

Thomas E. Clancy

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Univariate Analysis ◽

Locally Advanced ◽

Advanced Pancreatic Cancer ◽

Ductal Adenocarcinoma ◽

Resection Margins ◽

Borderline Resectable ◽

Stepwise Selection ◽

R1 Resection ◽

Positive Resection Margins

Background Many patients with borderline resectable/locally advanced pancreatic ductal adenocarcinoma (borderline resectable [BR]/locally advanced [LA] pancreatic ductal adenocarcinoma [PDAC]) undergoing resection will have positive resection margins (R1), which is associated with poor prognosis. It might be useful to preoperatively predict the margin (R) status. Methods Data from patients with BR/LA PDAC who underwent a pancreatectomy between 2008 and 2018 at Brigham and Women’s Hospital were retrospectively reviewed. Logistic regression analysis was used to evaluate the association between R status and relevant preoperative factors. Significant predictors of R1 resection on univariate analysis ( P < .1) were entered into a stepwise selection using the Akaike information criterion to define the final model. Results A total of 142 patients with BR/LA PDAC were included in the analysis, 60(42.3%) had R1 resections. In stepwise selection, the following factors were identified as positive predictors of an R1 resection: evidence of lymphadenopathy at diagnosis (OR = 2.06, 95% CI: 0.99-4.36, P = .056), the need for pancreaticoduodenectomy (OR = 3.81, 96% CI: 1.15-15.70, P = .040), extent of portal vein/superior mesenteric vein involvement at restaging (<180°, OR = 3.57, 95% CI: 1.00-17.00, P = .069, ≥180°, OR = 7,32, 95% CI: 1.75-39.87, P = .010), stable CA 19-9 serum levels (less than 50% decrease from diagnosis to restaging, OR = 2.27, 95% CI: 0.84-6.36 P = .107), and no preoperative FOLFIRINOX (OR = 2.17, 95% CI: 0.86-5.64, P = .103). The prognostic nomogram based on this model yielded a probability of achieving an R1 resection ranging from <5% (0 factors) to >70% (all 5 factors). Conclusions Relevant preoperative clinicopathological characteristics accurately predict positive resection margins in patients with BR/LA PDAC before resection. With further development, this model might be used to preoperatively guide surgical decision-making in patients with BR/LA PDAC.

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Microbiology of wound infection after oral cancer surgery

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2020.05.011 ◽

2020 ◽

Vol 48 (7) ◽

pp. 700-705

Author(s):

Margita Belusic-Gobic ◽

Arijan Zubovic ◽

Anamarija Predrijevac ◽

David Harmicar ◽

Robert Cerovic ◽

...

Keyword(s):

Oral Cancer ◽

Wound Infection ◽

Cancer Surgery

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Feasibility of MR Metabolomics for Immediate Analysis of Resection Margins during Breast Cancer Surgery

PLoS ONE ◽

10.1371/journal.pone.0061578 ◽

2013 ◽

Vol 8 (4) ◽

pp. e61578 ◽

Cited By ~ 41

Author(s):

Tone F. Bathen ◽

Brigitte Geurts ◽

Beathe Sitter ◽

Hans E. Fjøsne ◽

Steinar Lundgren ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Resection Margins ◽

Immediate Analysis

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Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure

Diseases of the Esophagus ◽

10.1093/dote/doab011 ◽

2021 ◽

Author(s):

Marianne C Kalff ◽

Mark I van Berge Henegouwen ◽

Suzanne S Gisbertz

Keyword(s):

Esophageal Cancer ◽

Cancer Surgery ◽

Quality Measure ◽

Resection Margins ◽

International Consensus ◽

Term Survival ◽

Intraoperative Complication ◽

Esophageal Cancer Surgery ◽

Perioperative Course

Summary Textbook outcome for esophageal cancer surgery is a composite quality measure including 10 short-term surgical outcomes reflecting an uneventful perioperative course. Achieved textbook outcome is associated with improved long-term survival. This study aimed to update the original textbook outcome based on international consensus. Forty-five international expert esophageal cancer surgeons received a personal invitation to evaluate the 10 items in the original textbook outcome for esophageal cancer surgery and to rate 18 additional items divided over seven subcategories for their importance in the updated textbook outcome. Items were included in the updated textbook outcome if ≥80% of the respondents agreed on inclusion. In case multiple items within one subcategory reached ≥80% agreement, only the most inclusive item with the highest agreement rate was included. With a response rate of 80%, 36 expert esophageal cancer surgeons, from 34 hospitals, 16 countries, and 4 continents responded to this international survey. Based on the inclusion criteria, the updated quality indicator ‘textbook outcome for esophageal cancer surgery’ should consist of: tumor-negative resection margins, ≥20 lymph nodes retrieved and examined, no intraoperative complication, no complications Clavien–Dindo ≥III, no ICU/MCU readmission, no readmission related to the surgical procedure, no anastomotic leakage, no hospital stay ≥14 days, and no in-hospital mortality. This study resulted in an international consensus-based update of a quality measure, textbook outcome for esophageal cancer surgery. This updated textbook outcome should be implemented in quality assurance programs for centers performing esophageal cancer surgery, and could standardize quality measures used internationally.

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