scholarly journals Frequency of Positive Surgical Margin at Prostatectomy and Its Effect on Patient Outcome

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Kenneth A. Iczkowski ◽  
M. Scott Lucia
Keyword(s):  
Patient Outcome ◽  
Tumor Cells ◽  
Surgical Margin ◽  
Positive Margin ◽  
Positive Surgical Margin ◽  
Positive Margins ◽  
Operator Experience ◽  
The Past ◽  
Psa Failure ◽  
Main Determinants

A positive surgical margin at prostatectomy is defined as tumor cells touching the inked edge of the specimen. This finding is reported in 8.8% to 42% of cases (median about 20%) in various studies. It is one of the main determinants of eventual biochemical (PSA) failure, generally associated with a doubled or tripled risk of failure. The effect of a positive margin on outcome can be modified by stage or grade and the length, number and location of positive margins, as well as by technical operative approach and duration of operator experience. This paper tabulates data from the past decade of studies on margin status.

Rate of Re-excision after Breast-conserving Surgery for Invasive Lobular Carcinoma

2013 ◽  
Vol 79 (10) ◽  
pp. 1119-1122 ◽  
Author(s):  
Morcos L. Wanis ◽  
Jennifer A. Wong ◽  
Samuel Rodriguez ◽  
Jasmine M. Wong ◽  
Brice Jabo ◽  
...  
Keyword(s):  
Invasive Lobular Carcinoma ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Surgical Margin ◽  
Positive Margin ◽  
Breast Conserving Surgery ◽  
Positive Surgical Margin ◽  
Close Margin ◽  
Cross Sectional ◽  
Positive Margins

Invasive lobular carcinoma (ILC) accounts for approximately 5 to 20 per cent of all breast cancers and is often multicentric. Despite pre- and intraoperative assessments to achieve negative margins, ILC is reported to be associated with higher rates of positive margin. This cross-sectional study examined patients with breast cancer treated at our institution from 2000 to 2010. The objective was to investigate the rate of re-excision resulting from positive or close margin (1 mm or less) in patients who underwent breast-conserving surgery (BCS) for ILC compared with invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). Of the 836 patients treated, 416 patients underwent BCS. The rate of re-excision after BCS for ILC was 35.1 versus 17.7 per cent for IDC and 20.0 per cent for DCIS ( P = 0.04). Re-excisions were more often performed for positive margin in patients with ILC (11 of 37 [29.7%]) versus IDC (36 of 334 [10.8%]) and DCIS (five of 45 [11.1%];( P = 0.004). In this single-institution review, BCS for ILC had significantly higher rates of re-excision as a result of positive margins when compared with IDC and DCIS. Tumor size greater than 2 cm and lymph node involvement were identified as factors associated with positive surgical margin in ILC. The higher possibility of positive margins and the need for additional procedures should be discussed with patients undergoing BCS for ILC.

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

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.

Oncologic significance of pathologic T2 positive surgical margin in robotic-assisted laparoscopic prostatectomy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15607-15607
Author(s):  
A. Levinson ◽  
D. S. Berkman ◽  
E. T. Goluboff ◽  
D. B. Samadi
Keyword(s):  
Linear Regression Analysis ◽  
Surgical Margin ◽  
Disease Free Survival ◽  
Positive Margin ◽  
Multiple Linear Regression Analysis ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Laparoscopic Prostatectomy ◽  
Pathologic Stage

15607 Background: A positive margin (PM) after radical prostatectomy (RP) in organ confined (pT2) prostate cancer (CaP) is considered a surgical error. In addition, capsular incision may occur at a higher frequency with robotic and laparoscopic techniques than with traditional open RP. However, the mechanism and significance of capsular violation may be different between open RP and Robotic Assisted Laparoscopic Prostatectomy (RALP). We sought to determine biochemical disease free survival (BDFS) for patients (pts) who underwent RALP at our institution who had a pT2 PM and compared them to those who did not. Methods: We reviewed our prospective IRB approved database for RALPs performed by a single surgeon. To permit adequate follow-up only cases prior to March 2006 were included. Biochemical failure (BF) strictly defined as any PSA >0.1ng/ml. No pt received adjuvant therapy without a BF. Results: Since Jan 2003, 435 consecutive pts underwent RALP for clinically localized CaP. 211 of these cases were before March 2006, of which 194/211 (92%) had sufficient data for analysis. Mean follow-up was 9.8 mos (range 0.7–41.6). Mean age, preoperative PSA, and path Gleason Score were 60 yrs, 6.6 ng/ml, and 6.9, respectively. Pathologic stages: pT2 77%; pT3a 13%; pT3b 7%, pT4 3%. Overall, 7.2% (14/194) experienced BF at a median of 2.5mos (0.7–15.3). BDFS rates by pathologic stage were pT2 95.3% (142/149), pT3a 91.7% (22/24), pT3b 76.9% (10/13), and pT4 71% (5/7). pT2 pts with a PM had the same rate of BF, (4.4% 1/23), as pT2 pts with negative margins (NM) (4.8% 6/126, p=0.932) and pT3 NM (0% 0/19, p=0.36), but was statistically less than pT3 PM (27.8% 5/18, p=0.035). In multiple linear regression analysis, preoperative PSA >10ng/ml was the most predictive variable of BF even after adjusting for Gleason sum, pathologic stage, and surgical margin status. Conclusions: There may be a different mechanism between a PM in organ confined open RP pts and RALP pts. In our series of RALPs, only one of 23 pT2 PM pts suffered a biochemical recurrence. BDFS for these pts was 95.7%, and did not vary significantly from pT2 NM nor pT3 NM pts. A larger series with longer follow-up will determine whether the oncologic significance of a PM in pT2 RALP pts is different than that of open RP pts. No significant financial relationships to disclose.

scholarly journals Assessment of breast cancer surgical margins with multimodal optical microscopy: A feasibility clinical study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0245334
Author(s):  
Mark T. Scimone ◽  
Savitri Krishnamurthy ◽  
Gopi Maguluri ◽  
Dorin Preda ◽  
Jesung Park ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Resolution ◽  
Optical Imaging ◽  
Predictive Value ◽  
Surgical Margin ◽  
Positive Margin ◽  
Breast Cancer Surgery ◽  
Preliminary Evaluation ◽  
Surgical Specimen ◽  
Positive Margins

Providing surgical margin information during breast cancer surgery is crucial for the success of the procedure. The margin is defined as the distance from the tumor to the cut surface of the resection specimen. The consensus among surgeons and radiation oncologists is that there should be no tumor left within 1 to maximum 2 mm from the surface of the surgical specimen. If a positive margin remains, there is substantial risk for tumor recurrence, which may also result in potentially reduced cosmesis and eventual need for mastectomy. In this paper we report a novel multimodal optical imaging instrument based on combined high-resolution confocal microscopy-optical coherence tomography imaging for assessing the presence of potential positive margins on surgical specimens. Since rapid specimen analysis is critical during surgery, this instrument also includes a fluorescence imaging channel to enable rapid identification of the areas of the specimen that have potential positive margins. This is possible by specimen incubation with a cancer specific agent prior to imaging. In this study we used a quenched contrast agent, which is activated by cancer specific enzymes, such as urokinase plasminogen activators (uPA). Using this agent or a similar one, one may limit the use of high-resolution optical imaging to only fluorescence-highlighted areas for visualizing tissue morphology at the sub-cellular scale and confirming or ruling out cancer presence. Preliminary evaluation of this technology was performed on 20 surgical specimens and testing of the optical imaging findings was performed against histopathology. The combination of the three imaging modes allowed for high correlation between optical image analysis and histological ground-truth. The initial results are encouraging, showing instrument capability to assess margins on clinical specimens with a positive predictive value of 1.0 and a negative predictive value of 0.83.

Oncological outcomes of positive surgical margins in partial nephrectomy for renal cell carcinoma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16079-e16079 ◽  
Author(s):  
Henrique T. S. Nonemacher ◽  
Mauricio Cordeiro ◽  
George Lins de Albuquerque ◽  
Fabio Galucci ◽  
Paulo Afonso de Carvalho ◽  
...  
Keyword(s):  
High Risk ◽  
Partial Nephrectomy ◽  
Surgical Margin ◽  
Positive Margin ◽  
Disease Recurrence ◽  
Surgical Margins ◽  
Positive Surgical Margin ◽  
Positive Surgical Margins ◽  
Risk Of Disease ◽  
Risk Of Relapse

e16079 Background: The prognostic significance and optimal management of positive surgical margins following partial nephrectomy remain controversial. The association between positive margin and risk of disease recurrence in patients with clinically localized renal neoplasm undergoing partial nephrectomy was evaluated. Methods: We analyzed the records of 429 patients cases of non-metastatic renal cell carcinoma who underwent partial nephrectomy (PN) at our institution, from 2001 to 2016. Recurrence free-survival was evaluated using Kaplan–Meier method and the log rank test and Cox models adjusting for tumor size, grade, histology, pathological stage, focality and laterality. The relationship between positive margin and risk of relapse was evaluated independently for pathological high risk (Fuhrman grades III-IV) and low risk (Fuhrman grades I-II) groups Results: A positive surgical margin was found in 55 (12.8%) patients. Recurrence developed in 26 (6%) patients during a median follow up of 39 months. A positive margin was associated with an increased risk of relapse on multivariable analysis (HR 3.19, CI 95% 1.21 – 7.61 p=0.02) (Table). In a stratified analysis based on pathological features, a positive surgical margin was significantly associated with a higher risk of recurrence in cases of high risk (HR 13.8, CI 95% 4.19–45.9, p = 0.0005). Conclusions: Positive surgical margins after partial nephrectomy increase the risk of disease recurrence, primarily in patients with high-risk pathological features. [Table: see text]

667: The Positive Surgical Margin (SM) is no Independent Predictor for Biochemical Failure after Radical Prostatectomy (RRP)

2005 ◽  
Vol 173 (4S) ◽  
pp. 182-182
Author(s):  
Rein J. Palisaar ◽  
Joachim Noldus ◽  
Alexander Haese ◽  
Markus Graefen ◽  
Hartwig Huland
Keyword(s):  
Radical Prostatectomy ◽  
Independent Predictor ◽  
Surgical Margin ◽  
Biochemical Failure ◽  
Positive Surgical Margin

scholarly journals Cost Analysis of Endoscopic Submucosal Dissection for the Treatment of Colorectal Lesions in China

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Ning Cui ◽  
Yu Zhao ◽  
Honggang Yu
Keyword(s):  
Colorectal Cancer ◽  
Cost Analysis ◽  
Endoscopic Submucosal Dissection ◽  
Transverse Colon ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Labor Costs ◽  
Positive Surgical Margins ◽  
Submucosal Dissection ◽  
Treatment Medication

Aim. The aim of the study was to evaluate costs associated with colonic endoscopic submucosal dissection (ESD) for treatment of colorectal cancer. Methods. The study is a retrospective analysis of data on 395 patients treated by colonic ESD. Results. The operation, consumable items, and medication accounted for 71% of the total costs for colonic ESD treatment. Medication and consumable items’ costs were higher if lesions occurred in the transverse colon and right hemicolon compared to the left hemicolon. Medication, consumable items, and total costs were higher for larger lesions. Lesion numbers and carcinoma were associated with higher medication, consumable items, operation, and total costs. Positive surgical margins and complications of hemorrhage or perforation were positively correlated with higher costs for medication, consumable items, and total costs. Conclusion. Labor costs for doctors and nurses remain low in China. Costs for medication and consumable items were higher for treatment involving the transverse colon or right hemicolon (vs. the left hemicolon), larger lesions, carcinoma, and a positive surgical margin. A benchmark cost estimate for ESD treatment including 4 days of postoperative hospitalization was determined to be approximately 5400 USD.

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