surgical margins
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2022 ◽  
Vol 2 ◽  
Author(s):  
Erika Crosetti ◽  
Giovanni Succo ◽  
Bruno Battiston ◽  
Federica D'Addabbo ◽  
Martina Tascone ◽  
...  

Purpose: The use of virtual surgical planning in head and neck surgery is growing strongly. In the literature, its validity, accuracy and clinical utility for mandibular reconstruction are widely documented. Virtual planning of surgical bone resection and reconstruction takes place several days before surgery and its very sensitive nature can negatively affect an intervention aimed at maximum precision in term of oncological safety.Methods: The study focuses on a retrospective evaluation of the surgical margins in 26 consecutive cases with oral cavity malignancy and who underwent computer-assisted mandibular resection/reconstruction guided by the different types of bone, periosteal and peri-mandibular tissue involvement. The goal was to analyze the strategic and technical aspects useful to minimize the risk of positive or close margins and to vary the reconstructive strategy in the case of intraoperative findings of a non-radical planned resection.Results: No intraoperative or perioperative complications occurred. In 20 patients, virtual surgical planning permitted mandibular reconstruction to be performed using composite fibular free flaps, characterized by high accuracy and negative bone margins. In the remaining 6 patients, also virtually planned but otherwise reconstructed due to poor general condition (advanced age, severe comorbidity), negative bone margins were obtained. Intraoperative enlargement of the resection was carried out in one case and positive soft tissue margins were observed in another case.Conclusion: The results were satisfactory in terms of oncological radicality and precision. The functional benefits and reduction in operating times, previously demonstrated in other articles also by the authors, seem to justify the side effects related to the risk of modifying the planned surgery. During virtual planning, the surgeons must bear in mind that an unexpected progression of the tumor or a limited planned resection will entail modifying the extent of the resection intraoperatively and nullifying the virtual planning on which the reconstruction was based. Further investigations are necessary to clarify all aspects of virtual surgical planning in this setting.


2021 ◽  
Vol 5 (1) ◽  
pp. 22-26
Author(s):  
Marcus Vinícius Jardini Barbosa ◽  
◽  
Anna Rita de Cascia Carvalho Barbosa ◽  
Frederico Alonso Sabino de Freitas

: Introduction: Non-melanoma skin cancer is a group of malignant neoplasms composed basically by sarcomas, basal cell carcinoma and squamous cell carcinoma. Its etiology is multifactorial with specificity for each of the two types, except for exposure to ultraviolet radiation, which is a common factor between both. When detected early, it has a high cure rate, and surgical excision with safety margins being the treatment of choice in most cases. Thus, it is important to recognize the profile of the patients, as well as the histopathological characteristics of the lesions and the medical approach used to avoid recurrences. Purpose: This study aimed to analyze the histopathological profile and surgical margins resulting from the resection of non-melanoma skin cancers in patients treated at a plastic surgery facility in Brazil. Methods: The cases of squamous cell carcinoma and the histopathological types of the basal cell carcinoma were individually analyzed for compromised margins, and later divided into a low-risk group and a high-risk group. Results: 228 lesions were resected from 141 patients. Gender distribution was 55.3% female and 44.6% male. The most affected age group was over 70 years old. The predominant histological type was basal cell carcinoma (74.6%) followed by squamous cell carcinoma (25.4%); the most affected site was the cephalic-cervical segment (71.92%). Surgical margins were compromised in 12.3% with no significant difference between the two types of carcinoma. Conclusion: There was a predominance of basal cell carcinoma (nodular type) in women over 40 years old, predominantly in the cephalic-cervical region. The number of recurrences was proportionally higher in the BCC, unrelated to the presence of positive margins. Keywords: Skin Neoplasms, Basal Cell Carcinoma, Squamous Cell Carcinoma, Recurrence, Margins of Excision.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261575
Author(s):  
Padmanabha Kumar Govindaraj ◽  
Thomas George Kallarakkal ◽  
Rosnah Mohd Zain ◽  
Wanninayake Mudiyanselage Tilakaratne ◽  
Huai Lin Lew

Background Local relapse of oral squamous cell carcinoma in non-involved mucosal surgical margins indicated possibility of field alteration in the margins, which could be predicted with certain biomarkers. The objectives were to evaluate the expression of Ki-67, Cornulin and ISG15 in non-involved mucosal surgical margins and the association of clinicopathological prognosticators with local relapse in oral squamous cell carcinoma. Methods Surgical margins from the study (relapse) group (n = 23), control (non-relapse) group (n = 32) and normal oral mucosa (n = 5) were immunohistochemically stained using Ki-67, Cornulin and ISG15 antibodies. Association between expression of markers and clinicopathological prognosticators with local relapse in oral squamous cell carcinoma was analyzed statistically. Results The study group surgical margins demonstrated significantly decreased Cornulin expression (p = 0.032). Low Cornulin expression was significantly associated with local relapse (p = 0.004) and non-tongue primary tumor (p = 0.013). Although not significantly associated with local relapse, expression of Ki-67 was significantly reduced in female patients (p = 0.041). Age above 57.5 years, Chinese & Indian ethnicity, alcohol consumption, epithelial dysplasia in surgical margins, and type III and IV patterns of invasion of tumor were also significantly related to local relapse. Regression analysis showed low expression of Cornulin (p = 0.018), and increased patient’s age (p = 0.008) were predictors of local relapse in oral squamous cell carcinoma, with 34-fold risk and 18-fold risk, respectively. Expression of Ki-67 and ISG15 did not show significant association with local relapse in oral squamous cell carcinoma. Conclusion Low expression of Cornulin is an independent predictor of relapse in oral squamous cell carcinoma.


Cancers ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 15
Author(s):  
Chung-Jan Kang ◽  
Yu-Wen Wen ◽  
Shu-Ru Lee ◽  
Li-Yu Lee ◽  
Chuen Hsueh ◽  
...  

(1) Background: The optimal cutoff value that maximizes the prognostic value of surgical margins in patients with resected oral cavity squamous cell carcinoma has not yet been identified. (2) Methods: Data for this study were retrieved from the Taiwan Cancer Registry Database. A total of 13,768 Taiwanese patients with oral cavity squamous cell carcinoma were identified and stratified according to different margin statuses (0, 0.1–4 and > 4 mm). The five-year local control, disease-specific survival and overall survival rates were the main outcome measures. (3) Results: The 5-year local control, disease-specific survival and overall survival rates of patients with close margins (0 and 0.1–4 mm) were significantly lower than those observed in patients with clear margins (> 4 mm; all p values < 0.001). In multivariate analysis, margin status, depth of invasion and extra-nodal extension were identified as independent adverse prognostic factors for 5-year local control. (4) Conclusions: A thorough assessment of surgical margins can provide a reliable prognostic prediction in patients with OCSCC. This has potential implications for treatment approaches tailored to the individual level. The achievement of clear margins (>4 mm) should be considered a key surgical goal to improve outcomes in this patient group.


2021 ◽  
Vol 10 (24) ◽  
pp. 5969
Author(s):  
Riccardo Lombardo ◽  
Riccardo Mastroianni ◽  
Gabriele Tuderti ◽  
Mariaconsiglia Ferriero ◽  
Aldo Brassetti ◽  
...  

(1) Aim: Robot assisted radical cystectomy (RARC) with intacorporeal neobladder (iN) is a challenging procedure. There is a paucity of reports on RARC-iN, the extracorporeal approach being the most used. The aim of our study was to assess the learning curve of RARC-iN and to test its performance in benchmarking Pasadena consensus outcomes. (2) Material and methods: The single-institution learning curve of RARC-iN was retrospectively evaluated. Demographic, clinical and pathologic data of all patients were recorded. Indications to radical cystectomy included muscle invasive bladder cancer (pT ≥ 2) or recurrent high grade non muscle invasive bladder cancer. The cumulative sum (CUSUM) technique, one of the methods developed to monitor the performance and quality of the industrial sector, was adopted by the medical field in the 1970s to analyze learning curves for surgical procedures. The learning curve was evaluated using the following criteria: 1. operative time (OT) <5 h; 2. 24-h Hemoglobin (Hb) drop <2 g/dl; 3. severe complications (according to the Clavien classification system) <30%; 4. positive surgical margins <5%; and 5. complete lymph-node dissection defined as more than 16 nodes. Benchmarking of all five items on quintile analysis was tested, and a failure rate <20% for any outcome was set as threshold. (3) Results: the first 100 consecutive RARC-iN patients were included in the analysis. At CUSUM analysis, RARC required 20 cases to achieve a plateau in terms of operative time (defined as more than 3 consecutive procedures below 300 min). Hemoglobin drop, PSM and number of removed lymph-nodes did not change significantly along the learning curve. Overall, 41% of the patients presented at least one complication. Low-grade and high-grade complication rates were 30% and 17%, respectively. When assessing the benchmarks of all five Pasadena consensus outcomes on quintile analysis, a plateau was achieved after the first 60 cases. (4) Conclusions: RARC-iN is a challenging procedure. The potential impact of the learning curve on significant outcomes, such as high grade complications and positive surgical margins, has played a detrimental effect on its widespread adoption. According to this study, in tertiary referral centers, 60 procedures are sufficient to benchmark all outcomes defined in Pasadena RARC consensus.


2021 ◽  
Vol 8 ◽  
Author(s):  
Thomas De Ridder ◽  
Paul Reddell ◽  
Pamela Jones ◽  
Graham Brown ◽  
Justine Campbell

Tigilanol tiglate (TT) is a novel small molecule registered as a veterinary pharmaceutical for intratumoural treatment of canine mast cell tumours (MCTs). The drug has a multifactorial mode of action resulting in rapid destruction of the treated tumour by haemorrhagic necrosis and subsequent slough of the necrotic tumour to reveal a tissue deficit that is left to heal by second intention with minimal to no veterinary intervention. Here we introduce the concept of TT-mediated margins, the calculated margin of tissue loss analogous to surgically applied margins to help clinicians conceptualise tissue deficits formed following tumour destruction by TT relative to surgical excision. We used data from 51 dogs that were recurrence-free 12 months after a single administered TT dose into a single target MCT &lt;10 cm3 in volume in a randomised, controlled clinical trial in the USA. We calculated TT-mediated margins based on length of the longest axis of (i) the tumour prior to treatment and (ii) the maximum tissue deficit formed 7–14 days after TT treatment. We compared these TT-mediated margins for each tumour to two surgical approaches to MCT excision in general practise: modified proportional margins (with 2 cm upper limit) and 3 cm fixed margins. For most dogs, TT-mediated margins were less than half the length of the margins calculated for the two surgical approaches in removing the same tumour. There was a trend for TT-mediated margins to increase with increasing tumour volume. Nonetheless, even for the larger tumours in this study (&gt;2 cm3 volume), 50% of TT-mediated margins were less than half the length of the two surgical margins. Eighteen cases were lower limb MCTs, sites often surgically challenging in veterinary practise. On these lower limbs, TT-mediated margins were less than half the length of the corresponding proportional margins in 56% of cases and larger than proportional margins in only two cases. This study suggests that, in many cases, smaller and more targeted margins could be expected when treating MCTs &lt;10 cm3 volume with TT compared with surgical excision. TT-mediated margins are a novel approach to conceptualise tissue deficits after intratumoural TT treatment.


Head & Neck ◽  
2021 ◽  
Author(s):  
Hugo Fontan Köhler ◽  
José Guilherme Vartanian ◽  
Clóvis Antônio Lopes Pinto ◽  
Ivete Fabelo Pereira Silva Rodrigues ◽  
Luiz Paulo Kowalski

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