P-248THE RISK FACTOR OF LOCAL RECURRENCE AT THE SURGICAL MARGIN IN PULMONARY WEDGE RESECTION

Abstract Background: Tertiary Gleason pattern 5 (TGP5) was found to be prognostic in prostate cancer (PCa) after radical prostatectomy (RP), but related data from China was rare. Our study was aimed at finding out the effect of TGP5 on PCa with Gleason score (GS) 7 and supplementing data from China in this field.Methods: A total of 229 cases met with inclusion criteria during Jan. 2014 to Dec. 2018 were reviewed. Cases were divided into GS 7 without TGP5 and GS 7 with TGP5. We compared age at diagnosis, preoperative PSA level, prostate volume, PSA density (PSAD), GS variation, clinical T staging, pathological T staging, T staging variation, extra-prostatic extension (EPE), positive surgical margin (PSM) and seminal vesicle invasion (SVI) between the groups. Effects of TGP5 on prognosis of PCa with GS 7 were evaluated using biochemical recurrence (BCR) as the primary end point.Results: TGP5 was related to higher PSM rate (P=0.001) and BCR rate (P=0.009) but not related to higher preoperative PSA level, larger prostate volume, higher PSAD, GS upgrade, poorer clinical/pathological T staging, T upstaging, EPE and SVI (all P>0.05). The median follow-up time was 24 months (interquartile range 17.5-45.5). TGP5 was an independent risk factor to PCa with GS 7 after RP using Kaplan-Meier log-rank test (P=0.018). Both univariable and multivariable cox-regression analysis pointed out that TGP5 increased the incidence of BCR in PCa with GS 7 (P<0.05). Stratified analyses were also done.Conclusion: TGP5 is an independent risk factor predicting of BCR after RP in PCa with GS 7 from China. TGP5 is related to higher PSM rate and BCR incidence. It is time to renew the contemporary Grading Group system with the consideration of TGP.

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Magnetic Anchor Technique Assisting with Video-Assisted Thoracoscopic Pulmonary Wedge Resection: A Clinical Study from China

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.08.578 ◽

2020 ◽

Vol 231 (4) ◽

pp. e217

Author(s):

Xiaopeng Yan ◽

Yixing Li ◽

Yong Zhang ◽

Yi Lyu

Keyword(s):

Clinical Study ◽

Wedge Resection ◽

Video Assisted ◽

Pulmonary Wedge Resection

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Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable?

Journal of Clinical Medicine ◽

10.3390/jcm9072266 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2266

Author(s):

Takamichi Ito ◽

Yumiko Kaku-Ito ◽

Maiko Wada-Ohno ◽

Masutaka Furue

Keyword(s):

Risk Factor ◽

Surgical Margin ◽

Disease Free Survival ◽

Positive Margin ◽

Breslow Thickness ◽

Acral Melanoma ◽

Kaplan Meier ◽

Group A ◽

Excision Margins ◽

Cancer Network

In this retrospective review of 100 patients with primary invasive acral melanoma, we examined whether narrow-margin excision is warranted for acral melanoma. Patients treated with surgical margins recommended by the National Comprehensive Cancer Network (R-group) were compared to those treated with narrow margins (N-group). A total of 65 patients underwent narrow-margin excision. Positive margin status or local recurrence rarely occurred regardless of the excision margins, whereas fatal events frequently occurred, particularly among the patients with T4 melanoma. The mortality rates of N- and R-group with T1–3 melanomas were similar (1.36 and 1.28 per 100 person-years, respectively). However, patients with T4 melanoma treated with narrow-margin excision had a higher mortality rate (11.44 vs. 5.03 per 100 person-years). Kaplan–Meier analyses showed a worse prognosis in the N-group (p = 0.045) but this group had thicker Breslow thickness (4.21 mm vs. 2.03 mm, p = 0.0013). A multivariate analysis showed that Breslow thickness was an independent risk factor, but surgical margin was not a risk factor for melanoma-specific survival or disease-free survival. In conclusion, although we could not find a difference between the narrow-margin excision and recommended-margin excision in this study, we suggest following current recommendations of guidelines. Our study warrants the prospective collection of data on acral melanoma to better define the prognosis of this infrequent type of melanoma.

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Does high-grade dysplasia/carcinoma in situ of the biliary duct margin affect the prognosis of extrahepatic cholangiocarcinoma? A meta-analysis

World Journal of Surgical Oncology ◽

10.1186/s12957-019-1749-7 ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 2

Author(s):

Qiao Ke ◽

Bin Wang ◽

Nanping Lin ◽

Lei Wang ◽

Jingfeng Liu

Keyword(s):

Local Recurrence ◽

Carcinoma In Situ ◽

Meta Analysis ◽

Surgical Margin ◽

High Grade Dysplasia ◽

Cochrane Library ◽

Biliary Duct ◽

High Grade ◽

Extrahepatic Cholangiocarcinoma

Abstract Background High-grade dysplasia/carcinoma in situ (HGD/CIS) of the biliary duct margin was found to not affect the prognosis of patients with extrahepatic cholangiocarcinoma by recent studies, but it has not yet reached a conclusion. Methods Eligible studies were searched by PubMed, PMC, MedLine, Embase, the Cochrane Library, and Web of Science, from Jan. 1, 2000 to Jun. 30, 2019, investigating the influences of surgical margin status of biliary duct on the prognosis of patients with resectable extrahepatic cholangiocarcinoma. Overall survival (OS) and local recurrence were evaluated by odds ratio (OR) with 95% confidence interval (CI). Results A total of 11 studies were enrolled in this meta-analysis, including 1734 patients in the R0 group, 194 patients in the HGD/CIS group, and 229 patients in the invasive carcinoma (INV) group. The pooled OR for the 1-, 2-, and 3-year OS rate between HGD/CIS group and R0 group was 0.98 (95% CI 0.65~1.50), 1.01 (95% CI 0.73~1.41), and 0.98 (95% CI 0.72~1.34), respectively. The pooled OR for the 1-, 2-, and 3-year OS rate between HGD/CIS group and INV group was 1.83 (95% CI 1.09~3.06), 4.52 (95% CI 2.20~9.26), and 3.74 (95% CI 2.34~5.96), respectively. Subgroup analysis of extrahepatic cholangiocarcinoma at early stage showed that the pooled OR for the 1-, 2-, and 3-year OS rate between HGD/CIS group and R0 group was 0.54 (95% CI 0.21~1.36), 0.75 (95% CI 0.35~1.58), and 0.74 (95% CI 0.40~1.37), respectively, and the pooled OR for the 1-, 2-, and 3-year OS rate between HGD/CIS group and INV group was 3.47 (95% CI 1.09~11.02), 9.12 (95% CI 2.98~27.93), and 9.17 (95% CI 2.95~28.55), respectively. However, the pooled OR for the incidence of local recurrence between HGD/CIS group and R0 group was 3.54 (95% CI 1.66~7.53), and the pooled OR for the incidence of local recurrence between HGD/CIS group and INV group was 0.93 (95% CI 0.50~1.74). Conclusion With the current data, we concluded that HGD/CIS would increase the risk of local recurrence compared with R0, although it did not affect the prognosis of patients with extrahepatic cholangiocarcinoma regardless of TNM stage. However, the conclusion needs to be furtherly confirmed.

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Postoperative acute kidney injury in patients with papillary renal cell carcinoma as a novel risk factor for local recurrence. Results from a large multicentric, observational study (the record 1 project)

European Urology Supplements ◽

10.1016/s1569-9056(19)33745-5 ◽

2019 ◽

Vol 18 (9) ◽

pp. e3315

Author(s):

P. Romagnani ◽

F. Di Maida ◽

A. Mari ◽

G. Novara ◽

A. Antonelli ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Acute Kidney Injury ◽

Risk Factor ◽

Local Recurrence ◽

Observational Study ◽

Cell Carcinoma ◽

Renal Cell ◽

Kidney Injury ◽

Papillary Renal Cell Carcinoma

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Platypnea–orthodeoxia syndrome after pulmonary wedge resection in a patient with severe scoliosis

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa003 ◽

2020 ◽

Vol 30 (5) ◽

pp. 790-791

Author(s):

Stefano Maria Donghi ◽

Giulia Sedda ◽

Juliana Guarize ◽

Lorenzo Spaggiari

Keyword(s):

Wedge Resection ◽

Upright Position ◽

Unique Case ◽

Severe Scoliosis ◽

Rare Syndrome ◽

Arterial Desaturation ◽

The Subject ◽

Pulmonary Wedge Resection

Abstract Platypnea–orthodeoxia is a rare syndrome characterized by dyspnoea and arterial desaturation, exacerbated by an upright position and relieved when the subject is recumbent. We report on a unique case of a patient with severe scoliosis who presented with several episodes of arterial desaturation after right pulmonary wedge resection.

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Frozen section analysis for organ-conserving surgery in penile cancer: Assessing oncological outcomes and trends of local recurrence

Journal of Clinical Urology ◽

10.1177/2051415820903192 ◽

2020 ◽

Vol 13 (6) ◽

pp. 419-424

Author(s):

T Ellul ◽

P Grice ◽

A Mainwaring ◽

N Bullock ◽

A Shanahan ◽

...

Keyword(s):

Local Recurrence ◽

Penile Cancer ◽

Frozen Section ◽

Surgical Margin ◽

Positive Margin ◽

Surgical Excision ◽

Recurrence Rates ◽

Level Of Evidence ◽

Positive Margins ◽

Positive Margin Rate

Introduction and objectives: The local recurrence rate of penile cancer following surgical excision is reported in many series to be between 6 and 29%. Intra-operative frozen section (FS) is a useful tool to ensure safe microscopic margins in organ-sparing procedures in penile cancer. In this series, we assessed the rates of positive margins and patterns of local recurrence in a multicentre cohort of patients undergoing penile-preserving surgery assisted by intra-operative FS analysis. Materials and methods: We reviewed all those patients for whom intra-operative FS was employed during penile-preserving surgery in three tertiary referral centres between 2003 and 2016. We assessed whether the use of FS altered the surgical technique and what affect it had on positive margins and recurrence rates. Results: A total of 169 patients were identified. Of these, intra-operative FS examination of the surgical margin was positive in 21 (12%) cases. Final histological examination confirmed cancer-free margins in all but one patient (99.4%). Overall, 9 patients developed local recurrence (5.3%). Conclusions: In this series, intra-operative FS contributed to a very low rate (5.3%) of local recurrence. We noted an extremely low positive margin rate (0.6%) which highlights the benefit of incorporating FS analysis into organ-preserving surgery for penile cancer. Level of evidence: Not applicable for this multicentre audit.

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