Resection Status Does Not Impact Recurrence in Well-Differentiated Liposarcoma of the Extremity

Background Well-differentiated liposarcoma (WDLPS) is a low-grade soft tissue sarcoma with a propensity for local recurrence. The necessity of obtaining microscopically free surgical margins (R0) to minimize local recurrence is not clear. This study evaluates recurrence-free survival (RFS) of extremity WDLPS in relation to resection margin status. Methods A retrospective review of adult patients with primary extremity WDLPS at seven US institutions from 2000 to 2016 was performed. Patients with recurrent tumors or incomplete resection (R2) were excluded. Clinicopathologic factors were analyzed to assess impact on local RFS. Results 97 patients with primary extremity WDLPS were identified. The majority of patients had deep, lower extremity tumors. Mean tumor size was 18.2±8.9cm. Patients were treated with either radical (76.3%) or excisional (23.7%) resections; 64% had R0 and 36% had microscopically positive (R1) resection margins. Ten patients received radiation therapy with no difference in receipt of radiation between R0 vs R1 groups. Thirteen patients (13%) developed a local recurrence with no difference in RFS between R0 vs R1 resection. Five-year RFS was 59.5% for R0 vs 85.2% for R1. Only one patient died of disease after developing dedifferentiation and distant metastasis despite originally having an R0 resection. Discussion In this large multi-institutional study of surgical resection of extremity WDLPS, microscopically positive margins were not associated with an increased risk of recurrence. Positive microscopic margin resection for extremity WDLPS may yield similar rates of local control while avoiding a radical approach to obtain microscopically negative margins.

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705 SIGNIFICANCE OF CLEAR CIRCUMFERENTIAL RESECTION MARGIN IN ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doab052.705 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Catherine Cheang ◽

Pradeep Patil

Keyword(s):

Esophageal Cancer ◽

Multimodal Therapy ◽

Resection Margin ◽

Locally Advanced ◽

Radical Resection ◽

Resection Margins ◽

R0 Resection ◽

Term Survival ◽

R1 Resection

Abstract Circumferential resection margins (CRM) of an esophagectomy specimen for oesophageal cancer is a key prognostic factor of overall survival (OS). This retrospective study aims to compare OS of post-esophagectomy patients with CRM of >1 mm (R0) and < 1 mm (R1) with further subgroup analysis of locally advanced T3R0 vs T3R1 resection. Methods A total of 110 esophagectomies conducted between 2010 and 2020 were analysed. We recorded R stage based on pathological CRM >1 mm (R0) or < 1 mm (R1). OS was calculated from the day of surgery to day of death or otherwise censored. All patients underwent multimodal therapy including chemotherapy and similar pre-surgical and post-surgical management. 58 of these patients with pT3 stage esophageal cancer (EC) were selected and compared. Statistical analysis was carried out using SPSS. Results Of 110 patients, 78 (71.5%) patients had a R0 resection. Mean OS in R0 resections was 73 months (6 years) compared to 25.2 months (2 years) in R1 resection (p = 0.001). 58 of the 110 patients were pathological stage T3(pT3) despite downstaging with chemotherapy showing the burden of advanced disease. In patients with stage pT3 (n = 58), 32 patients were R0 resections, and 26 patients had R1 resections. Mean OS in T3R0 resections was 51.5 months compared to 28.5 months in T3R1 resection. OS comparison is significant (p = 0.011). Conclusion This study emphasizes the importance of clear CRM in all patients and especially in locally advanced pT3/T4a esophageal cancer in achieving long term survival. Techniques used to ensure a clear CRM such multimodality therapy combined with surgical radical resection concepts such as mesoesophagectomy should be employed.

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Retrospective determination of the correlation between the distance of tumor manifestation to peripancreatic arteries and overall survival in primary resected pancreatic ductal adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15745 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15745-e15745

Author(s):

Uwe A Wittel ◽

Michael Uhl ◽

Frank Makowiec ◽

Ulrich Theodor Hopt ◽

Stefan Fichtner-Feigl ◽

...

Keyword(s):

Overall Survival ◽

Pancreatic Ductal Adenocarcinoma ◽

Median Survival ◽

Average Distance ◽

Ductal Adenocarcinoma ◽

Rank Test ◽

Resection Margins ◽

R0 Resection ◽

Borderline Resectable ◽

R1 Resection

e15745 Background: Current guidelines determine the resectability of PDAC by evaluating the contact of the tumor to peripancreatic vasculature. We wanted to evaluate the influence of this distance of the tumor to peripancreatic arteries on the overall survival of patients with primary resection of pancreatic ductal adenocarcinoma. Methods: Preoperative radiographs of 208 consecutive patients after distal pancreatectomy and/or pancreatoduodenectomy operated between 2007 and 2014 were included in the analysis. In reconstructions of CT and MRI data 90° planes to the centerline of the celiac trunc (CT), hepatic artery(HA) and superior mesenteric artery(SMA) were computed with Aquarius Intuition Viewer (V4.4.11, Terarecon). The closest distance between the tumor and the CT /HA and SMA was determined by an experienced pancreatic surgeon and radiologist independently and upon a deviation greater than 3 mm consent was reached by additional review in 33,2% (69/208) of the cases. Results: 176 CT and 32 MRI scans of 208 patients were evaluated. 2.4 % (5/208) of the radiographs were excluded due to insufficient quality. Average distance of the tumor to the CT/HA and SMA was 16.3 and 6.5 mm for PD and 12.7 and 11.0 mm for DP. Distance between the artery and the tumor did not influence the R0 resection rates (overall R0 > 1mm resection margin 64%) and median overall survival was 24.0 months after R0 resection and 13.5 months after R1 resection (log-rank test P < 0.05). Borderline resectable patients (n = 57) showed a median survival of 13.4 months, patients with their tumor 1-5mm distant to the closest artery (n = 65) and greater than 5 mm distance (n = 81) showed a median survival of 20.3 and 32.9 months respectively. Patients with 0-5 and greater than 5 mm distance between arteries and tumor showed a survival benefit from R0 resection (R0/R1 0-5mm 20.3/13.5 months; > 5mm 37.3/12.8 months) while R0 resected borderline resectable patients showed a similar survival than R1 resected patients (R0 12.7months, R1 15.1 months). Conclusions: The negative resection margins in borderline resectable patients not increase the survival when compared to R1 resected patients. Patients with primary R0 resection and initially large distance of the tumor to peripancreatic vasculature show a prolonged survival.

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Prognostic Factors in the Operative Management of Dedifferentiated Sacral Chordomas

Neurosurgery ◽

10.1227/neu.0000000000000423 ◽

2014 ◽

Vol 75 (3) ◽

pp. 269-275 ◽

Cited By ~ 14

Author(s):

Babar Kayani ◽

Mathew D. Sewell ◽

Sammy A. Hanna ◽

Asif Saifuddin ◽

William Aston ◽

...

Keyword(s):

Prognostic Factors ◽

Local Recurrence ◽

Sacroiliac Joint ◽

De Novo ◽

Malignant Tumors ◽

Spinal Tumors ◽

Resection Margins ◽

Tumor Diameter ◽

Increased Risk

Abstract BACKGROUND: Dedifferentiated chordomas are rare high-grade malignant spinal tumors for which there is minimal information to help guide treatment. OBJECTIVE: To identify prognostic factors associated with increased risk of local recurrence, metastases, and reduced survival in a cohort of patients undergoing sacrectomy for de novo dedifferentiated sacral chordoma. METHODS: Ten patients undergoing sacrectomy for histologically confirmed dedifferentiated chordoma at a specialist center were reviewed. There were 6 male and 4 female patients with a mean age of 66.7 years (range, 57-80 years) and mean follow-up of 36.7 months (range, 3-98 months). Data on prognostic factors were collected. RESULTS: The commonest presenting symptom was lumbar/gluteal pain. Mean duration of preoperative symptoms was 3.6 months (range, 2-7 months). Local recurrence was seen in 7 patients; metastases occurred in 5 patients. After sacrectomy, 7 patients died at a mean of 41 months (range, 3-98 months). Tumor size >10 cm in diameter, amount of dedifferentiation within the conventional chordoma, sacroiliac joint infiltration, and inadequate resection margins were associated with increased risk of recurrence and reduced survival. Surgical approach, cephalad extent of primary tumor, and adjuvant radiotherapy did not affect oncological outcomes. CONCLUSION: Dedifferentiated chordomas are aggressive malignant tumors with a higher risk of local recurrence, metastases, and early mortality than conventional chordomas. Tumor diameter >10 cm, marginal resection, and sacroiliac joint infiltration may be associated with increased risk of local recurrence and mortality. Those with a smaller burden of dedifferentiated disease (<1 cm2) within the primary chordoma have a better prognosis. Patients should be counseled about these risks before surgery and should have regular follow-up for the detection of local recurrence and metastases.

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Surgical treatment and long-term outcomes of low-grade myofibroblastic sarcoma: a single-center case series of 15 patients

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02454-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Jong-Ho Kim ◽

Woosuk Choi ◽

Hwan Seong Cho ◽

Kyu Sang Lee ◽

Joseph Kyu-hyung Park ◽

...

Keyword(s):

Surgical Treatment ◽

Local Recurrence ◽

Univariate Analysis ◽

Case Series ◽

Distant Metastases ◽

Resection Margins ◽

Low Grade ◽

Long Term Outcomes ◽

Myofibroblastic Sarcoma

Abstract Background Low-grade myofibroblastic sarcoma (LGMS) is a poorly studied, rare, soft tissue sarcoma. LGMS is characterized by a low malignancy potential, tendency for local recurrence, and low likelihood of distant metastases. However, no studies have reported on the surgical treatment method and its long-term outcomes. Methods We included all patients treated for LGMS at our institution between March 2010 and March 2021. Medical charts were retrospectively reviewed to collect demographic information, as well as information about the clinical course, tumor characteristics, and outcomes. Statistical analysis was performed to identify the factors associated with the recurrence rate. Results Fifteen patients who underwent surgical treatment were enrolled in this study. There were seven cases in the upper extremities, four in the trunk area, three in the lower extremities, and one in the head and neck area. There were no metastatic cases and two cases of local recurrence. Conclusions The incidence of LGMS in the extremities or trunk may be higher than expected based on the current literature. Univariate analysis showed that local tissue invasion and surgical method could be associated with local recurrence. Although further large studies are needed to establish risk factors of local recurrence or extent of resection margins, based on our study, wide local excision under the proper diagnosis is the most important treatment.

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Low-Grade Myofibroblastic Sarcoma (LGMS) of the Extremities – A Systematic Review and Case Report

10.21203/rs.3.rs-38829/v1 ◽

2020 ◽

Author(s):

Astrid Schenker ◽

Burkhard Lehner ◽

Ewgenija Gutjhar ◽

Gunhild Mechtersheimer ◽

Leila Harhaus ◽

...

Keyword(s):

Systematic Review ◽

Local Recurrence ◽

Distant Metastasis ◽

Cochrane Library ◽

Wide Resection ◽

Clinical Aspects ◽

Low Grade ◽

Incomplete Resection ◽

Myofibroblastic Sarcoma

Abstract Background: Low-grade myofibroblastic sarcoma (LGMS) is a rare subtype of soft tissue sarcoma of intermediate grade often representing fibromatosis-like features with a rare metastasing behavior. This type of tumor has a predilection for the head and neck region, but also occurs in the extremities. Confirming the diagnosis is difficult and treatment strategies have to be chosen individually.Methods: The objective of this study was to conduct a systematic review for LGMS of the extremities. The electronic databases PubMed and the Cochrane Library were searched for eligible studies. 141 abstracts were screened on PubMed, while 10 studies were identified as eligible. Cases were summarized in terms of clinical aspects, therapeutic regimen with the primary endpoint of follow-up controls regarding local recurrence or distant metastasis. In addition, we present the rare case and surgical management of a 28-year-old male patient with residual LGMS of the thumb after initial incomplete resection. Results: 33 cases of LGMS in the extremities were identified on PubMed. Cochrane library didn’t show any results. All of them were surgically resected. Only two cases of LGMS in the hand were described in literature so far. Treatment options varied from local excision to wide resection without exact definition of the safety distance. 26 cases provided follow-up information with local recurrence in 6 cases (23 %), while 4 cases (15 %) showed distant metastasis. Conclusions: Wide resection should be the surgical aim to avoid local recurrence and distant metastases. While the excision of tumors of the thumb and hand often require closer resection margins, due to the close proximity of anatomical structures, tumor-free margins are elementary even if tissue transfer from a donor site is needed for reconstruction.

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Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry

Endoscopy ◽

10.1055/a-1176-1107 ◽

2020 ◽

Vol 52 (11) ◽

pp. 1014-1023 ◽

Cited By ~ 1

Author(s):

Liselotte W. Zwager ◽

Barbara A. J. Bastiaansen ◽

Maxime E. S. Bronzwaer ◽

Bas W. van der Spek ◽

G. Dimitri N. Heine ◽

...

Keyword(s):

En Bloc Resection ◽

Bloc Resection ◽

Adverse Event Rate ◽

Resection Margins ◽

R0 Resection ◽

Incomplete Resection ◽

Full Thickness ◽

Technical Success ◽

En Bloc ◽

Endoscopic Full Thickness Resection

Abstract Background Endoscopic full-thickness resection (eFTR) is a minimally invasive resection technique that allows definite diagnosis and treatment for complex colorectal lesions ≤ 30 mm unsuitable for conventional endoscopic resection. This study reports clinical outcomes from the Dutch colorectal eFTR registry. Methods Consecutive patients undergoing eFTR in 20 hospitals were prospectively included. The primary outcome was technical success, defined as macroscopic complete en bloc resection. Secondary outcomes were: clinical success, defined as tumor-free resection margins (R0 resection); full-thickness resection rate; and adverse events. Results Between July 2015 and October 2018, 367 procedures were included. Indications were difficult polyps (non-lifting sign and/or difficult location; n = 133), primary resection of suspected T1 colorectal cancer (CRC; n = 71), re-resection after incomplete resection of T1 CRC (n = 150), and subepithelial tumors (n = 13). Technical success was achieved in 308 procedures (83.9 %). In 21 procedures (5.7 %), eFTR was not performed because the lesion could not be reached or retracted into the cap. In the remaining 346 procedures, R0 resection was achieved in 285 (82.4 %) and full-thickness resection in 288 (83.2 %). The median diameter of resected specimens was 23 mm. Overall adverse event rate was 9.3 % (n = 34/367): 10 patients (2.7 %) required emergency surgery for five delayed and two immediate perforations and three cases of appendicitis. Conclusion eFTR is an effective and relatively safe en bloc resection technique for complex colorectal lesions with the potential to avoid surgery. Further studies assessing the role of eFTR in early CRC treatment with long-term outcomes are needed.

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Limb preserving surgery for soft-tissue sarcoma in the hand: a retrospective study of 51 cases

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419899037 ◽

2020 ◽

Vol 45 (6) ◽

pp. 629-635 ◽

Cited By ~ 1

Author(s):

Mehran Dadras ◽

Hans-Ulrich Steinau ◽

Ole Goertz ◽

Marcus Lehnhardt ◽

Björn Behr ◽

...

Keyword(s):

Retrospective Study ◽

Soft Tissue ◽

Local Recurrence ◽

Soft Tissue Sarcoma ◽

Tumour Size ◽

Long Term Results ◽

Resection Margins ◽

Incomplete Resection ◽

Free Survival

Our retrospective study analysed the long-term results of a conservative limb-preserving surgical strategy in 51 patients with soft-tissue sarcoma of the hand from a single institution. We assessed survival and prognostic factors, including the surgical margins. No transradial amputations were performed. Microscopically free resection margins were obtained in 45 of the patients. The remaining six patients had microscopically incomplete resection. Forty-four surviving patients had a median follow-up of 6.5 years (range 12–307), and one patient had no follow-up beyond 3 months following surgery. Among those patients, 29 had more than 5 years of follow-up. Five-year local-recurrence-free survival was 65%, metastasis-free survival was 84%, and disease-specific survival was 91%. Tumour size was predictive of all outcome parameters, but positive resection margins adversely affected local recurrence only. Survival was similar to the survival after a more radical surgical approach reported in the literature. Level of evidence: IV

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Pathology and pathobiology of the oesophageal carcinoma

Acta chirurgica iugoslavica ◽

10.2298/aci1002015m ◽

2010 ◽

Vol 57 (2) ◽

pp. 15-26 ◽

Cited By ~ 1

Author(s):

M. Micev ◽

M. Cosic-Micev

Keyword(s):

Squamous Cell Carcinoma ◽

Lymph Node ◽

Cell Carcinoma ◽

Squamous Cell ◽

Oesophageal Carcinoma ◽

Low Grade ◽

Sentinel Node Concept ◽

Increased Risk ◽

Resection Margin Status ◽

History Of

Carcinoma of the oesophagus including carcinoma of gastro-oesophageal junction are rapidly increasing in incidence. During recent years there have been changes in the knowledge surrounding biology of the disease progression. Identification of dysplasia in mucosal biopsies is the most reliable pathologic indicator of an increased risk of development of squamous cell carcinoma and passes through the sequence of chronic esophagitis, low-grade and high-grade dysplasia and invasive carcinoma. Although Barrett's esophagus is a precursor to esophageal adenocarcinoma and have a well described sequence of carcinogenesis: the Barrett's metaplasia-dysplasia-adenocarcinoma sequence, not all patients with this disorder require intensive surveillance. The natural history of dysplasia is poorly understood, particularly in low-risk regions, and prospective follow-up studies are needed. Adjunctive methods to improve reproducibility, such as immunostaining for alpha-methylacyl-coenzyme A racemase (AMACR), show promise, but require confirmation in larger studies. In addition, several controversial methods such as detection of p16, p53, and DNA content abnormalities may help identify patients at particularly high risk for progression to cancer, but these techniques are not yet widely available for routine clinical application. More studies are needed to define other early nonmorphologic biomarkers for risk of squamous cell carcinoma. Recent evidence regarding the importance of several histopathologically derived prognostic factors, such as circumferential resection margin status and lymph node metastases are evaluated, including lymph node micrometastases and the sentinel node concept. With the rising use of multimodal treatments for oesophageal cancer it is important that the response of the tumour to this therapy can be carefully documented by histopathology.

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Clinical Outcomes of Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma of the Extremities: Analysis of Recurrence Factors

10.21203/rs.3.rs-508383/v1 ◽

2021 ◽

Author(s):

Toshiki Zeniya ◽

Makoto Emori ◽

Hiroyuki Tsuchie ◽

Hiroyuki Nagasawa ◽

Kousuke Iba ◽

...

Keyword(s):

Local Recurrence ◽

Clinical Outcomes ◽

Rank Test ◽

Low Grade ◽

Tumor Diameter ◽

Exact Test ◽

Time To Recurrence ◽

Average Maximum ◽

Maximum Tumor Diameter ◽

Well Differentiated

Abstract Background: Atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLPS) are low-grade, slow-growing, and locally aggressive tumors. We investigated clinical outcomes and recurrence factors for ALT/WDLPS of the extremities.Patients and Methods: The variables were evaluated as potential recurrence factor using Fisher’s exact test. The 5-year recurrence-free survival (RFS) rate was calculated using the Kaplan-Meier method, and differences in survival were assessed using a log-rank test in univariate analyses. Results: Sixty-two patients were identified, including 29 men and 33 women. The median age was 63.7 years (range, 34–82 years). The average maximum tumor diameter was 15.9 cm (range, 5–28 cm). The maximum tumor diameter (≥20 cm) was significantly associated with local recurrence (p=0.049). Ten patients (16.1%) developed local recurrence, and the mean time to recurrence was 48.4 months (range, 5–161 months).Conclusions: Tumor diameter ≥20 cm was identified as a risk factor for recurrence.

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Cystic duct dysplasia after cholecystectomy: a systematic review of the literature

International Surgery Journal ◽

10.18203/2349-2902.isj20195155 ◽

2019 ◽

Vol 6 (11) ◽

pp. 4192

Author(s):

Francesco Mongelli ◽

Agnese Cianfarani ◽

Matteo Di Giuseppe ◽

Antonjacopo Ferrario Di Tor Vajana ◽

Andrea Saporito ◽

...

Keyword(s):

Cystic Duct ◽

Cochrane Library ◽

Resection Margins ◽

R0 Resection ◽

Surveillance Program ◽

Low Grade ◽

Management Algorithm ◽

Positive Resection Margins ◽

Meta Analyses

Approximately 1 to 3.5% of cholecystectomies are found to have incidental dysplasia on histological examination. Cases of positive resection margins on the cystic stump are rare and evidence lack. The aim of this article was to systematically review the literature and to suggest a possible management algorithm. We searched PubMed, Cochrane Library and Google Scholar databases by combining “cholecystectomy” and “dysplasia” and “cystic” according to preferred reporting items for systematic reviews and meta-analyses guidelines. Studies providing information about cystic duct dysplasia with positive resection margin after cholecystectomy were included. We identified 113 articles, of which three were considered eligible. Five patients had a high-grade dysplasia, one patient had a carcinoma and one had a low-grade dysplasia. Median follow-up was of 10.5 months (range: 0.5-26.6 months), no evidence of recurrence was found in patients with dysplasia, while the patient with diagnosis of cholangiocarcinoma died during follow-up. Patients with positive resection margins for dysplasia after cholecystectomy should be considered for a surgical treatment according to clinical and pathological factors. Simple cystic duct stump excision was suggested and seems to be safe and effective with no evidence of recurrence during follow-up when a R0 resection is achieved. A multidisciplinary approach and a surveillance program should be always taken into account.

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