Impact of resection margin length and tumor depth on the local recurrence after thoracoscopic pulmonary wedge resection of a single colorectal metastasis

Abstract Background Radical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer. However, still some of the patients experienced cancer recurrence following radical resection. This study tried to identify the postoperative risk factors of local recurrence and distant metastasis separately. Methods This retrospective, single-center study comprised of 279 consecutive patients from Linkou branch of Chang Gung Memorial Hospital in 2005–2016 with rectal adenocarcinoma, pT1/T2N0M0 at distance from anal verge ≤ 8cm, who received curative radical resection. Results The study included 279 patients with pT1/pT2N0 mid-low rectal cancer with median follow-up of 73.5 months. Nineteen (6.8%) patients had disease recurrence in total. Nine (3.2%) of them had local recurrence, and fourteen (5.0%) of them had distant metastasis. Distal resection margin < 0.9 (cm) (hazard ratio = 4.9, p = 0.050) was the risk factor of local recurrence. Preoperative carcinoembryonic antigen (CEA) ≥ 5 ng/mL (hazard ratio = 9.3, p = 0.0003), lymph node yield (LNY) < 14 (hazard ratio = 5.0, p = 0.006), and distal resection margin < 1.4cm (hazard ratio = 4.0, p = 0.035) were the risk factors of distant metastasis. Conclusion For patients with pT1/pT2N0 mid-low rectal cancer, current multidisciplinary treatment brings acceptable survival outcome. Insufficient distal resection margin attracted the awareness of risk factors for local recurrence and distant metastasis as a foundation for future research.

Download Full-text

EP.TU.370A 5-year re-audit of quality indicators for potentially curative rectal cancer resections by a single surgeon

British Journal of Surgery ◽

10.1093/bjs/znab311.047 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Jessica Lockhart ◽

Damian McKay

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Resection Margin ◽

Length Of Hospital Stay ◽

Long Term Outcomes ◽

Recurrence Rates ◽

High Quality ◽

Curative Intent ◽

R1 Resection

Abstract Aim High quality operations with low rates of tumour perforation and circumferential resection margin (CRM) positivity are associated with improved long-term outcomes following surgery for rectal cancer. Previous audit has demonstrated lower rates of tumour perforation and CRM positivity by a single surgeon compared to the published standards. Our aim is to re-audit this surgeons’ outcomes for curative rectal resections. Methods Data was collected retrospectively for all potentially curative rectal resections over a 5-year period performed by a single surgeon using a local database and electronic care records. The CRM status and tumour perforation status were considered. Other end points included the rate of local recurrence, survival and length of stay. Results Fifty-one patients underwent rectal resections with curative intent, with a median age of 67. Complete resection (R0) was achieved in 94.1% of cases; 3.92% were found to have nodes less than 1mm from the margin and 1.96% were found to have tumour deposit less than 1mm from the margin – these cases were considered to be an R1 resection. Tumour perforation was present in 3.92% of cases, all of which had occurred pre-operatively. Local recurrence was found in 5.88% of cases and 90-day mortality was 1.96%. Median length of hospital stay was 7 days. Conclusion Our data demonstrates sustained high quality surgical outcomes with low tumour perforation rates and CRM positivity rates which compare favourably with the published standards to date. Local recurrence rates are comparable to published standards and 90-day mortality continues to be low.

Download Full-text

Pancreatic intra-epithelial neoplasia in resection margin and around pancreatic cancer predict local recurrence after pancreaticoduodenectomy

Pancreatology ◽

10.1016/j.pan.2018.05.359 ◽

2018 ◽

Vol 18 (4) ◽

pp. S133-S134

Author(s):

Mihailo Bezmarevic ◽

Darko Mirkovic ◽

Ivana Tufegdzic ◽

Milos Zaric ◽

Ivan Soldatovic ◽

...

Keyword(s):

Pancreatic Cancer ◽

Local Recurrence ◽

Resection Margin

Download Full-text

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

Download Full-text

Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group.

Journal of Clinical Oncology ◽

10.1200/jco.1996.14.3.869 ◽

1996 ◽

Vol 14 (3) ◽

pp. 869-877 ◽

Cited By ~ 417

Author(s):

J M Coindre ◽

P Terrier ◽

N B Bui ◽

F Bonichon ◽

F Collin ◽

...

Keyword(s):

Prognostic Factors ◽

Adjuvant Chemotherapy ◽

Local Recurrence ◽

Tumor Size ◽

Adjuvant Radiotherapy ◽

Tumor Depth ◽

Cancer Centers ◽

Grade 3 ◽

Metastatic Risk ◽

Deep Location

PURPOSE To define the prognostic factors in adult patients with locally controlled soft tissue sarcoma (STS) and to determine which patients should be considered for adjuvant treatment. PATIENTS AND METHODS Five hundred forty-six patients with a nonmetastatic and locally controlled STS, collected in a cooperative data base by the French Federation of Cancer Centers (FNCLCC) Sarcoma Group from 1980 and 1989, were studied. Histologic slides of all patients were collegially reviewed. Initial treatment consisted of complete tumor resection with amputation in only 4% of the patients. Adjuvant radiotherapy was administered to 57.9% and adjuvant chemotherapy to 31%. Relationships between tumor characteristics were analyzed, and univariate and multivariate analyses were performed using Cox models for the hazards rate of tumor mortality, development of distant metastasis, and strictly local recurrence. RESULTS Unfavorable characteristics with an independent prognostic value for tumor mortality were: grade 3 (P = 3 x 10(-10)), male sex (P = 1.5 x 10(-5)), no adjuvant chemotherapy (P = 5.4 x 10(-5)), tumor size > or = 5 cm (P = 3.8 x 10(-3)), and deep location (P = 4.6 x 10(-3)). Unfavorable characteristics for the development of distant metastasis were: grade 3 (P = 4 x 10(-12)), no adjuvant chemotherapy (P = 6.4 x 10(-4)), tumor size > or = 10 cm (P = 9.8 x 10(-4)), and deep location (P = 1.3 x 10(-3)). For the development of local recurrence, the unfavorable characteristics were: no adjuvant radiotherapy (P = 3.6 x 10(-6)), poor surgery (local excision) (P = 2 x 10(-4)), grade 3 (P = 7.6 x 10(-4)), and deep location (P = 10(-2)). Grade, depth, and tumor size were used to define groups of patients according to the metastatic risk. Adjuvant chemotherapy was beneficial in terms of overall survival and metastasis-free survival in grade 3 tumor patients only. Despite worse characteristics concerning tumor depth, tumor-node-metastasis (TNM) and American Joint Committee (AJC)/International Union Against Cancer (UICC) classifications and grade in patients with adjuvant radiotherapy, the latter experienced significantly fewer local recurrences than patients with no radiotherapy. CONCLUSION Grade, tumor depth, and tumor size could be used to select patients with a high metastatic risk, for which adjuvant chemotherapy could be beneficial.

Download Full-text

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.

Download Full-text

Is tubeless uniportal video-assisted thoracic surgery for pulmonary wedge resection a safe procedure?

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa061 ◽

2020 ◽

Vol 58 (Supplement_1) ◽

pp. i70-i76 ◽

Cited By ~ 3

Author(s):

Chao-Yu Liu ◽

Po-Kuei Hsu ◽

Ka-I Leong ◽

Chien-Kun Ting ◽

Mei-Yung Tsou

Keyword(s):

Thoracic Surgery ◽

Thoracoscopic Surgery ◽

Wedge Resection ◽

Chest Drain ◽

Safe Procedure ◽

X Rays ◽

Video Assisted Thoracic Surgery ◽

Video Assisted ◽

Clinically Significant ◽

Pulmonary Wedge Resection

Abstract OBJECTIVES Tubeless uniportal video-assisted thoracic surgery (VATS), using a uniportal approach and non-intubated anaesthesia while avoiding postoperative chest drain insertion, for patients undergoing thoracoscopic surgery has been demonstrated to be feasible in selected cases. However, to date, the safety of the procedure has not been studied. METHODS We reviewed consecutive patients undergoing non-intubated uniportal VATS for pulmonary wedge resection at 2 medical centres between August 2016 and October 2019. The decision to avoid chest drain insertion was made in selected candidates. For those candidates in whom a tubeless procedure was performed, postoperative chest X-rays (CXRs) were taken on the day of the surgery [operation (OP) day], on postoperative day 1 and 1–2 weeks later. The factors associated with abnormal CXR findings were studied. RESULTS Among 135 attempts to avoid chest drain insertion, 13 (9.6%) patients ultimately required a postoperative chest drain. Among 122 patients in which a tubeless procedure was performed, 26 (21.3%) and 47 (38.5%) had abnormal CXR findings on OP day and postoperative day 1, respectively. Among them, 3 (2.5%) patients developed clinically significant abnormal CXRs and required intercostal drainage. Primary spontaneous pneumothorax was independently associated with a higher risk of postoperative abnormal CXRs. CONCLUSIONS Tubeless uniportal VATS for pulmonary wedge resection can be safely performed in selected patients. Most patients with postoperative abnormal CXRs presented subclinical symptoms that spontaneously resolved; only 2.5% of patients with postoperative abnormal CXRs required drainage.

Download Full-text