scholarly journals Oncological Outcomes of Transoral Laryngeal Microsurgery with Fiber-Optic Diode Laser for Early Glottic Cancer: A Single-Center Experience

2021 ◽  
pp. 1-13
Author(s):  
Mehmet Hakan Korkmaz ◽  
Ömer Bayır ◽  
Esra Bozkurt Hatipoğlu ◽  
Emel Çadalli Tatar ◽  
Ünsal Han ◽  
...  
Keyword(s):  
Early Stage ◽  
Anterior Commissure ◽  
Survival Rates ◽  
Surgical Margin ◽  
Surgical Margins ◽  
Positive Surgical Margin ◽  
Single Center ◽  
Positive Surgical Margins ◽  
Histopathological Grade ◽  
T Stage

<b><i>Backgroud/Objectives:</i></b> Transoral laser laryngeal microsurgery (<sub>L</sub>TLM) has been widely used in the treatment of early-stage glottic laryngeal squamous cell carcinoma (LSCC) for the past few decades. Although T stage, tumor grade, anterior commissure involvement, type of cordectomy, positive surgical margin, and postoperative additional therapies were accused as the prognostic factors for recurrence, there is still controversy about these data in the literature. The purpose of this study was to evaluate the oncological results of our patients with early glottic LSCC treated with <sub>L</sub>TLM as a single-modality therapy in a single-center study. <b><i>Methods:</i></b> Patients with early-stage (T<sub>is-1–2</sub>/N<sub>0</sub>) glottic LSCC who underwent <sub>L</sub>TLM as a primary treatment from 2011 to 2019 were retrospectively reviewed. The clinicopathological factors and oncologic outcomes were analyzed. <b><i>Results:</i></b> One hundred and sixty-one patients were enrolled in this study. The 5-year overall (OS), disease-specific (DSS), disease-free (DFS), and laryngectomy-free survival rates were 84.5%, 97.9%, 79.2%, and 93.5%, respectively. The most common stage, histopathological type, and type of endoscopic cordectomy were T<sub>1</sub> stage, well-differentiated cancer, and type 2 cordectomy, respectively. A positive surgical margin was defined in 20 (12.4%) patients. There was a significant relationship between histopathological grade and positive surgical margins (<i>p</i> = 0.038). OS and DSS rates of “wait and see” modality were lower, while DFS of radiotherapy was lower than that of other treatment modalities in patients with positive surgical margins, but the differences were not statistically significant. Nineteen (11.8%) patients had a recurrence. DSS was statistically significantly lower in patients with recurrence (<i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> The results of our study showed that anterior commissure involvement, surgical margin positivity, and higher T stage statistically did not reduce survival rates in early-stage LSCC patients treated with <sub>L</sub>TLM. As the histopathological grade of the tumor worsens, the risk of surgical margin positivity increases. RT may have a negative effect on recurrence and organ preservation in the additional treatment of patient with positive surgical margins.

scholarly journals Reflector Localization of Breast Lesions and Parameters Associated with Positive Surgical Margins in Women Undergoing Breast Conservation Surgery

2020 ◽  
Vol 2 (5) ◽  
pp. 462-470
Author(s):  
Cherie M Kuzmiak ◽  
Suk Jung Kim ◽  
Sheila S Lee ◽  
Sheryl G Jordan ◽  
Kristalyn K Gallagher ◽  
...  
Keyword(s):  
Breast Conservation ◽  
Surgical Margin ◽  
Surgical Margins ◽  
Breast Conservation Surgery ◽  
Positive Surgical Margin ◽  
Breast Lesions ◽  
Positive Surgical Margins ◽  
Final Pathology ◽  
Lesion Type ◽  
Malignant Diagnosis

Abstract Objective To evaluate our experience with reflector localization of breast lesions and parameters influencing surgical margins in patients with a malignant diagnosis. Methods A retrospective institution review board–approved review of our institutional database was performed for breast lesions preoperatively localized from September 1, 2016, through December 31, 2017. Wire localizations were excluded. From electronic medical records and imaging, the following data was recorded: breast density, lesion type and size, reflector placement modality and number placed, reflector distance from lesion and skin, excision of lesion and reflector, tissue volume, margin status, and final pathology. Statistical analysis was performed with a Fisher’s exact test, Mann-Whitney test, and logistic regression. P &lt; 0.05 was significant. Results A total of 111 reflectors were deployed in the breasts of 103 women with 109 breast lesions. Ninety (81.1%) reflectors were placed under mammographic guidance and 21 (18.9%) under US. The lesions consisted of 68 (62.4%) masses, 17 (15.6%) calcifications, 2 (1.8%) architectural distortions, and 22 (20.2%) biopsy markers. Fourteen (21.2%) of 66 cases with a preoperative malignant diagnosis had a positive surgical margin. Final pathology, including 6 lesions upgraded to malignancy on excision, demonstrated 72 (66.0%) malignant, 22 (20.2%) high-risk, and 15 (13.8%) benign lesions. Univariate and multivariate analysis revealed no statistically significant parameters (lesion type or size, placement modality, reflector distance to skin or lesion, specimen radiography or pathology) were associated with a positive surgical margin. Conclusion Reflector localization is an alternative to wire localization of breast lesions. There were no lesion-specific or technical parameters affecting positive surgical margins.

Correlation of biologic recurrence after radical prostatectomy and a positive surgical margin with the predominant Gleason pattern on the specimen.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15145-e15145
Author(s):  
Yann Neuzillet ◽  
Audrey Pichon ◽  
Thierry Lebret ◽  
Jean-Pierre Raynaud ◽  
Henry Botto
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Cancer Patients ◽  
Surgical Margin ◽  
Surgical Margins ◽  
Rank Test ◽  
Multivariate Logistic Regression Model ◽  
Positive Surgical Margin ◽  
Positive Surgical Margins ◽  
Gleason Pattern

e15145 Background: The risk of biological recurrence following radical prostatectomy depends, among other factors, on surgical margins status. This study compared the prognosis of prostate cancer patients with positive surgical margins according to the predominant Gleason pattern (PrdGP). Methods: Prospective study of 247 consecutive prostate cancer patients, who underwent radical prostatectomy (RP) from 3/2007 to 12/2009, and were followed up in our institution. Pathological stage and Gleason score were determined in RP specimens by a pathological reference. Biological recurrence was defined as two consecutive values of PSA > 0.2 ng/mL. The median overall follow-up was 33 months (2 to 54 months). Biological recurrence-free survival was estimated and compared using Kaplan-Meier plots and Log rank test. A multivariate logistic regression model was done with PrdGP4, and two other predictive variables (pT≥3a, preoperative PSA level) entered as statistically significant independent predictors of biological recurrence. Results: Forty-eight patients (19.4%) had a positive surgical margins, 26 patients have PrdGP3 (54%) and 22 have PrdGP4 (46%). Whereas 7 biological recurrences were observed in PrdGP4 patients, none occurred in PrdGP3 patients. Biological recurrence-free survivals were significantly different (Log rank p=0.001). In multivariate analysis, PrdGP4 was a predictor of biological recurrence (p<0.0001, OR= 9.023, 95% CI [3.161–25.757]). Conclusions: This study demonstrates that biological recurrence after positive surgical margin are correlated with the predominant Gleason pattern assessed on radical prostatectomy specimen which s more easily evaluable than accurate margins features. Adjuvant treatment, specifically external beam radiotherapy, should be indicated in accordance to this result. [Table: see text]

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]

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.

scholarly journals What Are The Determinants of Parametrial Invasion In Patients With Early Stage Cervical Cancer: A Cross Sectional Study

2021 ◽  
Author(s):  
Niloufar Hoorshad ◽  
Narges Zamani ◽  
Shahrzad Sheikh Hasani ◽  
Amirhossein Poopak ◽  
Amirsina Sharifi
Keyword(s):  
Cervical Cancer ◽  
Tumor Size ◽  
Early Stage ◽  
Univariate Analysis ◽  
Surgical Margin ◽  
P Value ◽  
Positive Surgical Margin ◽  
Stromal Invasion ◽  
Number Of Patients ◽  
Early Stage Cervical Cancer

Abstract Background: There was an increase in number of patients presented with early-stage cervical cancer (CC). Tumors with favorable pathological features might be candidates for less radical surgery.Methods: We retrospectively reviewed 700 patients with histologically confirmed CC between January 2011 and March 2020. Chi-square, Fisher's exact tests and multivariate logistic regression analysis were used to assess relations between parametrial involvement (PI) and clinic-pathological variables.Results: Total number of 132 patients with stage IA to IIA were eligible to participate. Squamous cell carcinoma was reported in 100 (75.8%) patients, adenocarcinoma and other tumor pathologies were found in 24(18.2%) and 8(6.1%), respectively. Considering the FIGO stage, 11 (8.4%) patients had IA, 111 (83%%) IB and 10 (7.6%) IIA. Nine patients (6.8%) had PI on permanent pathologic report. Univariate analysis demonstrated that following variables were statistically different between patients with and without PI: age ≥ 50, tumor size ≥ 3cm, lower segment involvement, poorly differentiated pathology, deep stromal invasion, pelvic lymph node, lympho-vascular involvement and positive surgical margin (all p values < 0.05). Among these variables only tumor size ≥ 3 cm (OR: 2.1, 95% CI: 1.11-4.16, p value: 0.02), deep stromal invasion (OR: 2.2, 95% CI: 1.9-7.43, p value: 0.02) and positive surgical margin (OR: 5.1, 95% CI: 3.97-11.15, p value: 0.008) were independent risk factor of PI in multivariate analysis.Conclusions: Early stage CC can be surgically approached in a more conservative manner if patients have tumor size < 3 cm and do not have deep stromal invasion in conization.

Setting standards for cystectomy using the British Association of Urological Surgeons Complex Operations Reports, 2016–2018

2021 ◽  
pp. 205141582110334
Author(s):  
Joseph B John ◽  
John Pascoe ◽  
Sarah Fowler ◽  
Edward Rowe ◽  
Alexandra Colquhoun ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Surgical Margin ◽  
Public Understanding ◽  
British Association ◽  
Invasive Bladder Cancer ◽  
Positive Surgical Margin ◽  
Muscle Invasive Bladder Cancer ◽  
Level Of Evidence ◽  
T Stage ◽  
Muscle Invasive

Objective: To produce comprehensive standards for cystectomy using contemporary data collected across a nation. Patients and methods: Surgical departments upload cystectomy data to the British Association of Urological Surgeons (BAUS) Complex Operations Database. Analysis of 2016–2018 data was performed for all recorded 5288 patients undergoing cystectomy in England. Logistic regression with general linear models was used to assess differences in patient selection between operative modalities. Analysis involved assessment of case selection, operative decisions and outcomes, case volume and pathological outcomes. Results: Using national Hospital Episode Statistics, the BAUS cystectomy dataset was estimated 93% complete. Median age was 70 years (interquartile range 63–75) and 75% were male. Charlson comorbidity index ⩽2 was reported in 87%. Primary treatment of muscle-invasive bladder cancer accounted for 46% of cases. Commonest preoperative disease stages were T2N0 and T1N0 (35% and 25% respectively). Robotic-assisted (RAC), laparoscopic (LC) and open cystectomy (OC) were performed in 41%, 5.5% and 54% of cases respectively. T-stage distribution differed by operative modality. Transfusion rates were 3.7% for RAC, 6.0% for LC and 18% for OC. Increasing positive surgical margin rates were observed with increasing T-stage, up to T3. The conversion-to-open rate for minimally-invasive surgery was 1.7%. Median annual centre and surgeon case volumes were highest for RAC. Median length of stay was 7, 10 and 10 days for RAC, LC and OC respectively. Postoperative histological upstaging was common (33% of cT1, 50% of cT2 cases). Lymph node positive rates were 28% for muscle-invasive bladder cancer. Conclusion: Analysis of this data provides understanding of ‘real-world’ cystectomy practice. Presentation of data specific to operative modality allows surgeons and centres to benchmark their respective practices. These findings offer to enhance patient and public understanding beyond that currently facilitated by publicly-facing information sources. They carry relevance by describing a near-complete and large volume of modern practice in a publicly funded healthcare system. Level of evidence: 2b

Sarcomas of the Nasal Cavity and Paranasal Sinuses

1994 ◽  
Vol 103 (9) ◽  
pp. 699-704 ◽  
Author(s):  
Joel A. Sercarz ◽  
Rufus J. Mark ◽  
Ian Storper ◽  
Luu Tran ◽  
Thomas C. Calcaterra
Keyword(s):  
Los Angeles ◽  
Paranasal Sinuses ◽  
Adjuvant Radiotherapy ◽  
Combined Modality Therapy ◽  
Surgical Margin ◽  
Surgical Margins ◽  
Low Grade ◽  
Positive Surgical Margins ◽  
Key Issues ◽  
The University

Sarcomas of the nose and paranasal sinuses are rare malignancies. Key issues remain unresolved in the management of these tumors, particularly with regard to the role of radiotherapy. To help clarify these issues, 48 consecutive cases of nasal and paranasal sinus sarcomas treated at the University of California, Los Angeles, between 1958 and 1988 were retrospectively reviewed. Six of 16 patients managed initially with surgery alone were cured. All had negative surgical margins and 5 of the 6 had low-grade tumors. Of 5 patients with high-grade lesions treated with surgery only, 1 was rendered free of disease. Twelve patients with positive surgical margins were treated with adjuvant radiotherapy; 5 were cured with this approach. Grade and surgical margin status were found to be significantly related to outcome for sinonasal sarcoma. There were 14 patients with rhabdomyosarcoma; 3 were cured with modern combined-modality therapy. Patients with positive surgical margins should be treated with adjuvant radiotherapy. Surgical therapy is effective for low-grade lesions that are completely excised.

scholarly journals Clinical, Pathological, and Prognostic Analysis of Urachal Carcinoma

2021 ◽  
pp. 1-10
Author(s):  
Guangjun Shao ◽  
Chunru Xu ◽  
Jikai Liu ◽  
Xuesong Li ◽  
Luchao Li ◽  
...  
Keyword(s):  
High Risk ◽  
Surgical Margin ◽  
Partial Cystectomy ◽  
Tnm Stage ◽  
Histologic Grade ◽  
Positive Surgical Margin ◽  
Urachal Carcinoma ◽  
Prognostic Features ◽  
T Stage ◽  
Significant Difference

<b><i>Objective:</i></b> The aim of this study was to improve understanding the clinical, pathologic, and prognostic features of urachal carcinoma (UrC), a retrospectively descriptive study was done in 2 clinical centers. <b><i>Methods:</i></b> After excluding the 2 missed patients, the clinical and pathological data of 59 patients with UrC, who were diagnosed or treated at 2 clinical centers between 1986 and 2019, was retrospectively analyzed. SPSS 22.0 (IBM) and GraphPad Prism 8.0.1 were used for statistics and data visualization. Survival data were analyzed by the Kaplan-Meier method and Log-rank tests. Cox proportional hazards regression were performed for find risk factors on predicting the prognosis. <b><i>Results:</i></b> Of all 59 patients, 47 were male and 12 were female. The median age at diagnosis was 51.6 years (range: 22–84 years). Gross hematuria was the most common symptom (79.66%). The majority of urachal neoplasms were adenocarcinomas (94.92%). Forty-two patients (72.41%) underwent extended partial cystectomy with en bloc resection of the entire urachus. The mean follow-up was 52 months (3–277 months). Median overall survival was 52.8 months (4–93 months). The 3-year cancer-specific survival (CSS) rate and 5-year CSS rate were 69.1% and 61.2%. There was no significant difference among localized T stage, tumor histologic grade and surgical procedures in determining prognosis by survival analyze. While patients with high-risk TNM stage (local abdominal metastasis, lymph node metastasis, or distant metastasis) (<i>p</i> = 0.003) and positive surgical margin (<i>p</i> &#x3c; 0.001) had significantly worse prognosis. <b><i>Conclusions:</i></b> The results indicate that high-risk TNM stage and positive surgical margin are risk predictors of prognosis. Localized T stage, histologic grade, and surgical procedure cause no significant effect on patient prognosis. The extended partial cystectomy is the recommended surgical approach for patients with UrC. Active multimodal treatments may improve the survival of patients with recurrent and metastatic disease.

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