Objective Multiparametric magnetic resonance imaging(MRI)has become the standard of care for the diagnosis of prostate cancer patients.This study aimed to evaluate the influence of preoperative MRI on the positive sur...Objective Multiparametric magnetic resonance imaging(MRI)has become the standard of care for the diagnosis of prostate cancer patients.This study aimed to evaluate the influence of preoperative MRI on the positive surgical margin(PSM)rates.Methods We retrospectively reviewed 1070 prostate cancer patients treated with radical prostatectomy(RP)at Siriraj Hospital between January 2013 and September 2019.PSM rates were compared between those with and without preoperative MRI.PSM locations were analyzed.Results In total,322(30.1%)patients underwent MRI before RP.PSM most frequently occurred at the apex(33.2%),followed by posterior(13.5%),bladder neck(12.7%),anterior(10.7%),posterolateral(9.9%),and lateral(2.3%)positions.In preoperative MRI,PSM was significantly lowered at the posterior surface(9.0%vs.15.4%,p=0.01)and in the subgroup of urologists with less than 100 RP experiences(32%vs.51%,odds ratio=0.51,p<0.05).Blood loss was also significantly decreased when a preoperative image was obtained(200 mL vs.250 mL,p=0.02).Multivariate analysis revealed that only preoperative MRI status was associated with overall PSM and PSM at the prostatic apex.Neither the surgical approach,the neurovascular bundle sparing technique,nor the perioperative blood loss was associated with PSM.Conclusion MRI is associated with less overall PSM,PSM at apex,and blood loss during RP.Additionally,preoperative MRI has shown promise in lowering the PSM rate among urologists who are in the early stages of performing RP.展开更多
This study was designed to define possible preoperative predictors of positive surgical margin after laparoscopic radical prostatectomy. We retrospectively analyzed the records of 296 patients with prostate cancer dia...This study was designed to define possible preoperative predictors of positive surgical margin after laparoscopic radical prostatectomy. We retrospectively analyzed the records of 296 patients with prostate cancer diagnosed by prostate biopsy, and eventually treated with laparoscopic radical prostatectomy. The prognostic impact of age, prostate volume, preoperative prostate-specific antigen, biopsy Gleason score, maximum percentage tumor per core, number of positive cores, biopsy perineurat invasion, capsule invasion on imaging, and tumor laterality on surgical margin was assessed. The overall positive surgical margin rate was 29.1%. Gleason score, number of positive cores, perineural invasion, tumor laterality in the biopsy specimen, and prostate volume significantly correlated with risk of positive surgical margin by univariate analysis （P 〈 0.05）. Gleason score （odds ratio [OR] = 2.286, 95% confidence interval [95% CI] = 1.431-3.653, P= 0.001）, perineural invasion （OR = 4.961, 95% CI = 2.656-9.270, P〈 0.001）, and number of positive cores （OR = 4.403, 95% CI = 1.878-10.325, P = 0.001） were independent predictors of positive surgical margin at the multivariable logistic regression analysis. Patients with perineural invasion, higher biopsy Gleason scores and/or a large number of positive cores in biopsy pathology had more possibility of capsule invasion. The positive surgical margin rate in patients with capsule invasion （49.5%） was much higher than that with localized disease （17.8%）. In contrast, prostate volume showed a protective effect against positive surgical margin （OR = 0.572, 95% CI = 0.346-0.945, P = 0.029）. Gleason score, perineural invasion, and number of positive cores in the biopsy specimen were preoperative independent predictors of positive surgical margin after laparoscopic radical prostatectomy while prostate volume was a protective factor against positive surgical margin.展开更多
We investigated the relationship between positive surgical margin(PSM)-related factors and biochemical recurrence(BCR)and the ability of intraoperative frozen sections to predict significant PSM in patients with prost...We investigated the relationship between positive surgical margin(PSM)-related factors and biochemical recurrence(BCR)and the ability of intraoperative frozen sections to predict significant PSM in patients with prostate cancer.The study included 271 patients who underwent robot-assisted laparoscopic prostatectomy with bilateral nerve sparing and maximal urethral preservation.Intraoperative frozen sections of the periurethra,dorsal vein,and bladder neck were analyzed.The ability of PSM-related factors to predict BCR and significant PSM was assessed by logistic regression.Of 271 patients,108(39.9%)had PSM and 163(60.1%)had negative margins.Pathologic Gleason score^8(18.9%vs 7.5%,P=0.015)and T stage≥T3a(51.9%vs 24.6%,P<0.001)were significantly more frequent in the PSM group.Multivariate analysis showed that Gleason pattern≥4(vs<4;hazard ratio:4.386;P=0.0004)was the only significant predictor of BCR in the PSM cohort.Periurethral frozen sections had a sensitivity of 83.3%and a specificity of 84.2%in detecting PSM with Gleason pattern≥4.Multivariate analysis showed that membranous urethra length(odds ratio[OR]:0.79,P=0.0376)and extracapsular extension of the apex(OR:4.58,P=0.0226)on magnetic resonance imaging(MRI)and positive periurethral tissue(OR:17.85,P<0.0001)were associated with PSM of the apex.PSM with Gleason pattern≥4 is significantly predictive of BCR.Intraoperative frozen sections of periurethral tissue can independently predict PSM,whereas sections of the bladder neck and dorsal vein could not.Pathologic examination of these samples may help predict significant PSM in patients undergoing robot-assisted laparoscopic prostatectomy with preservation of functional outcomes.展开更多
Objective:No standard strategy for diagnosis and management of positive surgical margin(PSM)and local recurrence after partial nephrectomy(PN)are reported in literature.This review aims to provide an overview of the c...Objective:No standard strategy for diagnosis and management of positive surgical margin(PSM)and local recurrence after partial nephrectomy(PN)are reported in literature.This review aims to provide an overview of the current strategies and further perspectives on this patient setting.Methods:A non-systematic review of the literature was completed.The research included the most updated articles(about the last 10 years).Results:Techniques for diagnosing PSMs during PN include intraoperative frozen section,imprinting cytology,and other specific tools.No clear evidence is reported about these methods.Regarding PSM management,active surveillance with a combination of imaging and laboratory evaluation is the first option line followed by surgery.Regarding local recurrence management,surgery is the primary curative approach when possible but it may be technically difficult due to anatomy resultant from previous PN.In this scenario,thermal ablation(TA)may have the potential to circumvent these limitations representing a less invasive alternative.Salvage surgery represents a valid option;six studies analyzed the outcomes of nephrectomy on local recurrence after PN with three of these focused on robotic approach.Overall,complication rates of salvage surgery are higher compared to TA but ablation presents a higher recurrence rate up to 25%of cases that can often be managed with repeat ablation.Conclusion:Controversy still exists surrounding the best strategy for management and diagnosis of patients with PSMs or local recurrence after PN.Active surveillance is likely to be the optimal first-line management option for most patients with PSMs.Ablation and salvage surgery both represent valid options in patients with local recurrence after PN.Conversely,salvage PN and radical nephrectomy have fewer recurrences but are associated with a higher complication rate compared to TA.In this scenario,robotic surgery plays an important role in improving salvage PN and radical nephrectomy outcomes.展开更多
<strong>Background:</strong> Many patients who have had radical prostatectomy for prostate cancer may present with microscopic extraprostatic extension of the disease. Positive surgical margins are a commo...<strong>Background:</strong> Many patients who have had radical prostatectomy for prostate cancer may present with microscopic extraprostatic extension of the disease. Positive surgical margins are a common pathological finding in this subgroup of patients. To report the epidemiological, clinical and therapeutic aspects of PSM after radical prostatectomy (RP) and to evaluate the follow-up of patients. <strong>Patients and methods:</strong> A single-center retrospective descriptive study of patients who underwent radical prostatectomy between June 1, 2004 and December 31, 2019 was conducted. Patients who had radical prostatectomy with PSM on pathology report were included. The parameters studied were age, initial prostate specific antigen (PSA), Gleason and International Society of Uropathology (ISUP) scores, cTNM and pTNM stages, operative technique, PSA levels after surgery, adjuvant treatment and patient survival. <strong>Results:</strong> Eighty-six (86) radical prostatectomies were performed. PSM was found in 23 patients (26.7%). The mean age of the patients was 63.7 ± 6.1 years. The mean preoperative total PSA was 31.5 ng/mL (6.31 - 146 ng/mL). Prostate biopsy showed only prostatic adenocarcinoma. Thoracic-abdominopelvic CT was performed in all patients. Prostate cancers were found at the localized stage in 12 patients and locally advanced in 11 patients. A classification adjustment was obtained after pathological examination of the surgical specimen. The ISUP score 3 and 1 on the surgical specimen were in the majority with 9 and 7 patients respectively. After the recurrence, all patients who consented received hormone therapy, which was either medical with Goserelin and Triptorelin (7 patients) or surgical with testicular pulpectomy (1 patient). PSA was undetectable (<0.1 mg/mL) in 4 patients. The mean overall survival (OS) time was 28.1 months. Biological recurrence-free survival in the series was 25.7 months. <strong>Conclusion:</strong> RP with PSM is a fairly common condition that varies from less than 10% to more than 40% depending on the stage of the disease and the operators, and for which the main mean of treatment in our practice setting is hormone therapy.展开更多
Objective Positive surgical margins(PSMs)after radical prostatectomy(RP)indicate failure of surgery to completely clear cancer.PSMs confer an increased risk of biochemical recurrence(BCR),but how more robust outcomes ...Objective Positive surgical margins(PSMs)after radical prostatectomy(RP)indicate failure of surgery to completely clear cancer.PSMs confer an increased risk of biochemical recurrence(BCR),but how more robust outcomes are affected is unclear.This study investigated factors associated with PSMs following RP and determined their impact on clinical outcomes(BCR,second treatment[radiotherapy and/or androgen deprivation therapy],and prostate cancer-specific mortality[PCSM]).Methods The study cohort included men diagnosed with prostate cancer(pT2-3b/N0/M0)between January 1998 and June 2016 who underwent RP from the South Australian Prostate Cancer Clinical Outcomes Collaborative database.Factors associated with risk of PSMs were identified using Poisson regression.The impact of PSMs on clinical outcomes(BCR,second treatment,and PCSM)was assessed using competing risk regression.Results Of the 2827 eligible participants,28%had PSMs—10%apical,6%bladder neck,17%posterolateral,and 5%at multiple locations.Median follow-up was 9.6 years with 81 deaths from prostate cancer recorded.Likelihood of PSM increased with higher pathological grade and pathological tumor stage,and greater tumour volume,but decreased with increasing surgeon volume(odds ratio[OR]:0.93;95%confidence interval[CI]:0.88-0.98,per 100 previous prostatectomies).PSMs were associated with increased risk of BCR(adjusted sub-distribution hazard ratio[sHR]2.5;95%CI 2.1-3.1)and second treatment(sHR 2.9;95%CI 2.4-3.5).Risk of BCR was increased similarly for each PSM location,but was higher for multiple margin sites.We found no association between PSMs and PCSM.Conclusion Our findings support previous research suggesting that PSMs are not independently associated with PCSM despite strong association with BCR.Reducing PSM rates remains an important objective,given the higher likelihood of secondary treatment with associated comorbidities.展开更多
Surgical margin is an important prognosticator in patients undergoing hepatectomy for colorectal liver metastases(CRLM)(1).However,the incidence of cut-end recurrence is relatively low,approximately 5-20%,even in pati...Surgical margin is an important prognosticator in patients undergoing hepatectomy for colorectal liver metastases(CRLM)(1).However,the incidence of cut-end recurrence is relatively low,approximately 5-20%,even in patients with pathologically positive(R1)resection(1).Therefore,cut-end recurrence is not an underlying cause of poor prognosis in patients with narrow surgical margin,but it is thought to reflect tumor progression and biology(1,2).展开更多
Background Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with p...Background Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China, it is necessary to investigate the risk of positive surgical margin and biochemical recurrence, and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study, we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macao area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the proanosis of these oatients.展开更多
Background:Positive surgical margins are independent risk factor for biochemical recurrence,local recurrence,and distant metastasis after radical prostatectomy.However,limited predictive tools are available.This study...Background:Positive surgical margins are independent risk factor for biochemical recurrence,local recurrence,and distant metastasis after radical prostatectomy.However,limited predictive tools are available.This study aimed to develop and validate a preoperative nomogram for predicting positive surgical margins after laparoscopic radical prostatectomy(LRP).Methods:From January 2010 to March 2016,a total of 418 patients who underwent LRP without receiving neoadjuvant therapy at Peking University Third Hospital were retrospectively involved in this study.Clinical and pathological results of each patient were collected for further analysis.Univariable and multivariable logistic regression(backward stepwise method)were used for the nomogram development.The concordance index(CI),calibration curve analysis and decision curve analysis were used to evaluate the performance of our model.Results:Of 418 patients involved in this study,142 patients(34.0%)had a positive surgical margin on final pathology.Based on the backward selection,four variables were included in the final multivariable regression model,including the percentage of positive cores in preoperative biopsy,clinical stage,free prostate specific antigen(fPSA)/total PSA(tPSA),and age.A nomogram was developed using these four variables.The concordance index(C-index)of the nomogram was 0.722 in the development cohort and 0.700 in the bootstrap validations.The bias-corrected calibration plot showed a limited departure from the ideal line with a mean absolute error of 2.0%.In decision curve analyses,the nomogram showed net benefits in the range from 0.2 to 0.7.Conclusion:A nomogram to predict positive surgical margins after LRP was developed and validated,which could help urologists plan surgical procedures.展开更多
Objective With increased incidence of prostate cancer and an increased number of patients undergoing radical prostatectomy in China, it will be necessary to elaborate the diagnosis, clinical significance and treatment...Objective With increased incidence of prostate cancer and an increased number of patients undergoing radical prostatectomy in China, it will be necessary to elaborate the diagnosis, clinical significance and treatment of patients whose tumors have positive surgical margins following radical prostatectomy.Data sources Positive surgical margin, prostate cancer and radical prostatectomy were used as subject words and the medical literature in recent decades was searched using the PubMed database and the results are summarized.Study selection Using positive surgical margin, prostate cancer and radical prostatectomy as subject words the PubMed medical database produced 275 papers of pertinent literature. By further screening 28 papers were selected and they represent relatively large-scale clinical randomized and controlled clinical trials.Results A pertinent literature of 275 papers was identified and 28 papers on large clinical studies were obtained. Analysis of results indicated that the positive rate of surgical margin after radical prostatectomy is 20%-40%, and although most patients with positive surgical margins are stable for a considerable period, the data available now suggested that the presence of a positive surgical margin will have an impact on the patient＇s prognosis. The risk factors of positive surgical margin include preoperative prostate specific antigen level, Gleason＇s score and pelvic lymph node metastasis. The most common site with positive surgical margin is in apical areas of the prostate; therefore surgical technique is also a factor resulting in positive surgical margins. From data available now it appears that as long as the surgical technique is skilled, different surgical modes do not affect the rate of surgical margin. Adjuvant radiotherapy is mainly used to treat patients with positive surgical margin after radical prostatectomy, but combination with androgen deprivation therapy may increase the curative effect.Conclusion The current data indicated that the presence of positive surgical margins can markedly affect the patient＇s prognosis. Therefore we should be aware how we reduce the positive surgical margin, how to diagnose positive surgical margin and how to treat when there are positive surgical margins.展开更多
As for resection for colorectal liver metastasis (CRLM), secur-ing an adequate surgical margin is important for achieving a better prognosis. However, it is often difficult to achieve ade-quate margins for the resecti...As for resection for colorectal liver metastasis (CRLM), secur-ing an adequate surgical margin is important for achieving a better prognosis. However, it is often difficult to achieve ade-quate margins for the resection of CRLM. So the current sur-vival impact of sub-centi/millimeter surgical margins in he-patectomy for CRLM should be evaluated. In the current era of multidisciplinary treatment options, this review focused on the prognostic impact of a sub-centi/millimeter surgical margin width in hepatectomy for CRLM. We systematically reviewed retrospective studies that clearly described the sur-gical margin width for hepatectomy for CRLM. We selected studies conducted since 2000 that involved patients diag-nosed as having CRLM. We focused on studies that investi-gated not only surgical margins, but also microscopic surgical curability such as R0 (microscopically complete resection) or R1 (microscopically incomplete resection), which clearly de-scribe their definitions. Based on our literature review, 1, 2, or 5 mm was considered the minimum surgical margin width for hepatectomy for CRLM. Although a surgical margin width of 1 mm is acceptable for hepatectomy for CRLM, submil-limeter margins, which are defined as R1 in many reports, are only acceptable for limited patients such as those who have undergone preoperative chemotherapy. Zero-mm mar-gins are also acceptable in limited patients such as those who show a good response to preoperative chemotherapy. New chemotherapy agents have been reported to reduce the prognostic impact of a narrow surgical margin width. The incidence of margin recurrence, which is a major concern regarding R1 resection of CRLM, is about 20-30% according to the majority of earlier reports. As evaluations of the actual prognostic impact of the surgical margin remain difficult, fur-ther study is warranted.展开更多
Aim:One of the most important factors associated with recurrence rate and overall survival is the status of surgical margin of resection free of disease.However,sometimes,the margins measured intra-operatively at the ...Aim:One of the most important factors associated with recurrence rate and overall survival is the status of surgical margin of resection free of disease.However,sometimes,the margins measured intra-operatively at the time of surgery differ of those measured by the pathologist in the histopathologic analysis.Faced with this dilemma,a literature review of the best available evidence was conducted in an attempt to determine how the phenomenon of tissue shrinkage may influence on the surgical margin of resection in patients undergoing oral and oropharyngeal squamous cell carcinoma(SCC).Methods:An electronic and manual search was conducted by one reviewer.A combination of controlled Medical Subjects Headings and keywords were used as search strategy.Inclusion and exclusion criteria were established.Results:Finally,after an exhaustive selection process,four articles fulfilled the inclusion criteria and were analyzed.All articles reported a decrease of surgical margin after resection.The tumor site and tumor stage seem to influence in degree of margin shrinkage.Conclusion:Tissue shrinkage on surgical margins of resection in oral SCC is a tangible phenomenon.There is a significant discrepancy between margins measured intraoperatively previous to resection and margins measured by pathologist after histologic processing.The highest percentage of retraction occurs at the time of resection.Margin shrinkage based on tumor site and tumor stage should be considered by any oncologic surgeon to ensure adequate margins of resection cleared of tumor.展开更多
Objective:Microscopically positive resection margins(R1)in gastric cancer have been associated with poor outcomes,but evidence regarding its prognostic significance across different stages remains inconsistent.This st...Objective:Microscopically positive resection margins(R1)in gastric cancer have been associated with poor outcomes,but evidence regarding its prognostic significance across different stages remains inconsistent.This study investigated the impact of R1 resection on survival outcomes and evaluated the prognostic significance of detailed pathological characteristics of margin involvement.Methods:This retrospective study analyzed 10,165 patients who underwent curative-intent gastrectomy for gastric cancer between 2007 and 2021.Propensity score matching was performed at a 1:3 ratio between R1(n=45)and R0(n=130)cases.For R1 margins,detailed pathological assessment included involvement length,proportion,depth,and histological features.Survival outcomes were evaluated across all stages,and the impact of subsequent resection was analyzed.Results:After propensity score matching,R1 resection showed significantly lower 5-year overall survival rates compared to R0 resection across all stages(stageⅠ:60.0%vs.90.9%,P=0.008;stageⅡ:40.0%vs.83.3%,P=0.001;stageⅢ:20.0%vs.35.4%,P<0.001).In R1 cases,tumor involvement length≤1 cm(P<0.001),proportion≤10%(P=0.012),and mucosal-only involvement(P=0.004)were associated with better survival.Patients who underwent subsequent resection to achieve R0 status showed better survival than those with persistent R1 resection(53.8%vs.26.7%,P<0.001)and comparable survival to matched R0 cases(53.8%vs.46.9%,P=0.320).Conclusions:R1 resection significantly impairs survival across all stages of gastric cancer,with the extent and depth of microscopic involvement influencing prognosis.When R1 status is discovered postoperatively,subsequent resection should be considered to improve survival outcomes.展开更多
To analyze the learning curve for cancer control from an initial 250 cases （Group I） and subsequent 250 cases （Group II） of robotic-assisted laparoscopic radical prostatectomy （RALP） performed by a single surgeo...To analyze the learning curve for cancer control from an initial 250 cases （Group I） and subsequent 250 cases （Group II） of robotic-assisted laparoscopic radical prostatectomy （RALP） performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups, Positive surgical margin （PSM） and biochemical recurrence （BCR） were assessed as cancer control outcomes. Patients in Group II had significantly more advanced prostate cancer than those in Group I （22.2% vs 14.2%, respectively, with Gleason score 8-10, P = 0.033; 12.8% vs 5.6%, respectively, with clinical stage T3, P = 0.017）. The incidence of PSM in pT3 was decreased significantly from 49% in Group I to 32.6% in Group Ih A meaningful trend was noted for a decreasing PSM rate with each consecutive group of 50 cases, including pT3 and high-risk patients. Neurovascular bundle （NVB） preservation was significantly influenced by the PSM in high-risk patients （84.1% in the preservation group vs 43.9% in the nonpreservation group）. The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased significantly after 250 cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50 cases. NVB preservation during RALP for the high-risk group is not suggested due to increasing PSM.展开更多
BACKGROUND A positive resection margin is a major risk factor for local breast cancer recurrence after breast-conserving surgery(BCS).Preoperative imaging examinations are frequently employed to assess the surgical ma...BACKGROUND A positive resection margin is a major risk factor for local breast cancer recurrence after breast-conserving surgery(BCS).Preoperative imaging examinations are frequently employed to assess the surgical margin.AIM To investigate the role and value of preoperative imaging examinations[magnetic resonance imaging(MRI),molybdenum target,and ultrasound]in evaluating margins for BCS.METHODS A retrospective study was conducted on 323 breast cancer patients who met the criteria for BCS and consented to the procedure from January 2014 to July 2021.The study gathered preoperative imaging data(MRI,ultrasound,and molybdenum target examination)and intraoperative and postoperative pathological information.Based on their BCS outcomes,patients were categorized into positive and negative margin groups.Subsequently,the patients were randomly split into a training set(226 patients,approximately 70%)and a validation set(97 patients,approximately 30%).The imaging and pathological information was analyzed and summarized using R software.Non-conditional logistic regression and LASSO regression were conducted in the validation set to identify factors that might influence the failure of BCS.A column chart was generated and applied to the validation set to examine the relationship between pathological margin range and prognosis.This study aims to identify the risk factors associated with failure in BCS.RESULTS The multivariate non-conditional logistic regression analysis demonstrated that various factors raise the risk of positive margins following BCS.These factors comprise non-mass enhancement(NME)on dynamic contrastenhanced MRI,multiple focal vascular signs around the lesion on MRI,tumor size exceeding 2 cm,type III timesignal intensity curve,indistinct margins on molybdenum target examination,unclear margins on ultrasound examination,and estrogen receptor(ER)positivity in immunohistochemistry.LASSO regression was additionally employed in this study to identify four predictive factors for the model:ER,molybdenum target tumor type(MT Xmd Shape),maximum intensity projection imaging feature,and lesion type on MRI.The model constructed with these predictive factors exhibited strong consistency with the real-world scenario in both the training set and validation set.Particularly,the outcomes of the column chart model accurately predicted the likelihood of positive margins in BCS.CONCLUSION The proposed column chart model effectively predicts the success of BCS for breast cancer.The model utilizes preoperative ultrasound,molybdenum target,MRI,and core needle biopsy pathology evaluation results,all of which align with the real-world scenario.Hence,our model can offer dependable guidance for clinical decisionmaking concerning BCS.展开更多
The presence of a positive deep surgical margin in tongue squamous cell carcinoma(TSCC)significantly elevates the risk of local recurrence.Therefore,a prompt and precise intraoperative assessment of margin status is i...The presence of a positive deep surgical margin in tongue squamous cell carcinoma(TSCC)significantly elevates the risk of local recurrence.Therefore,a prompt and precise intraoperative assessment of margin status is imperative to ensure thorough tumor resection.In this study,we integrate Raman imaging technology with an artificial intelligence(AI)generative model,proposing an innovative approach for intraoperative margin status diagnosis.This method utilizes Raman imaging to swiftly and non-invasively capture tissue Raman images,which are then transformed into hematoxylin-eosin(H&E)-stained histopathological images using an AI generative model for histopathological diagnosis.The generated H&E-stained images clearly illustrate the tissue’s pathological conditions.Independently reviewed by three pathologists,the overall diagnostic accuracy for distinguishing between tumor tissue and normal muscle tissue reaches 86.7%.Notably,it outperforms current clinical practices,especially in TSCC with positive lymph node metastasis or moderately differentiated grades.This advancement highlights the potential of AI-enhanced Raman imaging to significantly improve intraoperative assessments and surgical margin evaluations,promising a versatile diagnostic tool beyond TSCC.展开更多
BACKGROUND Fibroadenomas(FA)and phyllodes tumors(PT)are fibroepithelial neoplasms and are difficult to differentiate radiographically and histologically.We present a partially infarcted borderline PT in an adolescent ...BACKGROUND Fibroadenomas(FA)and phyllodes tumors(PT)are fibroepithelial neoplasms and are difficult to differentiate radiographically and histologically.We present a partially infarcted borderline PT in an adolescent with rapid tumor enlargement within 24 hours.Tumor infarction made the diagnostic work-up difficult.Com-plete surgical excision is the standard of care for PTs.There is controversy regar-ding margin re-excision for borderline PTs.In this report,we discuss the diagno-stic challenges of PT and the evolving concept of margin status on PT recurrence rate.CASE SUMMARY A 14-year-old healthy female with no medical history presented with a painful right breast mass with no nipple discharge,trauma,or skin findings.The mass showed rapid enlargement over 24 hours,prompting a workup with ultrasound and core needle biopsy.The initial biopsy was limited due to large areas of in-farction.Based on the scant viable tissue and considering the patient’s age,the mass was favored to be a juvenile FA.The patient underwent excision of the mass.Final pathology confirmed a borderline PT with positive surgical margins.The patient underwent margin re-excision,which did not show any residual tumor.At the 6-month post-op visit,there was a mass-forming lesion on the breast ultrasound.Subsequent core needle biopsy showed benign breast parenchyma with scar formation.The primary goal of evaluation in pediatric breast masses is to do no harm.However,rapidly growing and symptomatic masses require a more extensive work-up including biopsy and surgical excision.We present a rapidly growing breast mass in a 14-year-old female which was diagnosed as a borderline PT on her excision specimen.The mass rapidly enlarged over 24 hours.The initial biopsy pathology was limited due to a large area of infarction.The patient underwent excision of the mass.Final pathology confirmed a borderline PT that extended into the surgical margin,resulting in an additional re-excision procedure.Accurate diagnosis prior to surgical intervention is crucial to avoid additional procedures.Although histological morphology remains the gold standard for diagnosis,immunohistochemistry and molecular studies have recently shown to improve the accuracy of diagnosis of PTs.Long-term clinical and pathologic follow-up of PTs in adolescent patients should be collectively studied to examine whether our current diagnostic criteria for PT can reliably predict tumor behavior in this age group.CONCLUSION Accurate diagnosis of PTs requires surgical excision.Tumor infarction may lead to rapid tumor enlargement,hindering the correct diagnosis.More research is needed on margin status and recurrence rate,especially in adolescent patients,to help establish the best possible care for this age group.展开更多
Objective:To explore clinicopathological predictors of adverse pathological changes(APCs)(upgrading,upstaging,and positive surgical margin[PSM])after robot-assisted radical prostatectomy(RARP)in clinical tumor stage 2...Objective:To explore clinicopathological predictors of adverse pathological changes(APCs)(upgrading,upstaging,and positive surgical margin[PSM])after robot-assisted radical prostatectomy(RARP)in clinical tumor stage 2c(cT2c)prostate cancer(PCa)patients.Methods:From January 2018 to December 2022,cT2cN0M0 PCa patients who underwent prostate biopsies and subsequent RARP at the Peking University First Hospital with an interval between biopsy and RARP of ≤90 days were included.Univariable and stepwise multivariable logistic regression analyses were performed to identify independent risk factors associated with APCs.Nomograms were constructed based on these predictive models.The performance of the nomograms was evaluated by receiver operating characteristic curves,decision curve analyses,and calibration plots.Results:A total of 423 eligible cT2cN0M0 PCa patients were included.The rates of upgrading,upstaging,and PSM in our cohortwere 33%,51%,and 35%,respectively.The stepwise multivariate logistic analysis suggested that PSA density and the percentage of positive cores in systematic biopsy were significantly associated with the occurrence of APCs.The score of the Prostate Imaging Reporting and Data System,PSA density,and the International Society of Urological Pathology grade group(IGG)of needle-biopsy specimens(or clinical IGG[cIGG])were significantly associated with upgrading.The PSA density,percentage of positive cores in systematic biopsy,and largest tumor percentage in all cores of each patient(LTP)were significantly associated with upstaging.The PSA density and LTP were significantly associatedwith the PSM.Based on these results,four nomogramswere developed.Receiver operating characteristic curves,decision curve analyses,and calibration plots implied that the nomograms exhibited excellent accuracy.Conclusion:The predictive models we developed could help to identify high-risk PCa early,and optimize clinical decisions of cT2cN0M0 PCa patients.展开更多
BACKGROUND The long-term effect of anatomic resection(AR)is better than that of nonanatomic resection(NAR).At present,there is no study on microvascular invasion(MVI)and liver resection types.AIM To explore whether AR...BACKGROUND The long-term effect of anatomic resection(AR)is better than that of nonanatomic resection(NAR).At present,there is no study on microvascular invasion(MVI)and liver resection types.AIM To explore whether AR improves long-term survival in patients with hepatocellular carcinoma(HCC)by removing the peritumoral MVI.METHODS A total of 217 patients diagnosed with HCC were enrolled in the study.The surgical margin was routinely measured.According to the stratification of different tumor diameters,patients were divided into the following groups:≤2 cm group,2-5 cm group,and>5 cm group.RESULTS In the 2-5 cm diameter group,the overall survival(OS)of MVI positive patients was significantly better than that of MVI negative patients(P=0.031).For the MVI positive patients,there was a statistically significant difference between AR and NAR(P=0.027).AR leads to a wider surgical margin than NAR(2.0±2.3 cm vs 0.7±0.5 cm,P<0.001).In the groups with tumor diameters<2 cm,both AR and NAR can obtain a wide surgical margin,and the surgical margins of AR are wider than that of NAR(3.5±5.8 cm vs 1.6±0.5 cm,P=0.048).In the groups with tumor diameters>5 cm,both AR and NAR fail to obtain wide surgical margin(0.6±1.0 cm vs 0.7±0.4 cm,P=0.491).CONCLUSION For patients with a tumor diameter of 2-5 cm,AR can achieve the removal of peritumoral MVI by obtaining a wide incision margin,reduce postoperative recurrence,and improve prognosis.展开更多
Since the first report on laparoscopic distal pancreatectomy (LDP) appeared in the 1990s, the procedure has been performed increasingly frequently to treat both benign and malignant lesions of the pancreas. Many earli...Since the first report on laparoscopic distal pancreatectomy (LDP) appeared in the 1990s, the procedure has been performed increasingly frequently to treat both benign and malignant lesions of the pancreas. Many earlier publications have shown LDP to be a good alternative to open distal pancreatectomy for benign lesions, although this has never been studied in a prospective, randomized manner. The evidence for the use of LDP to treat adenocarcinoma of the pancreas is not as well established. The purpose of this review is to evaluate the current evidence for LDP in cases of pancreatic adenocarcinoma. We conducted a review of English language publications reporting LDP results between 1990 and 2013. All studies reporting results in patients with histologically proven pancreatic adenocarcinoma were included. Thirty-nine publications were found and included in the results for a total of 309 cases of pancreatic adenocarcinoma (potential double publications were not eliminated). Most LDP procedures are performed in selected cases and generally involve smaller tumors than open distal pancreatectomy (ODP) procedures. Some of the papers report unselected cases and include procedures on larger tumors. The number of lymph nodes harvested using LDP is comparable to the number obtained with ODP, as is the frequency of R0 resections. Current data suggest that similar short term oncological results can be obtained using LDP as those obtained using ODP.展开更多
文摘Objective Multiparametric magnetic resonance imaging(MRI)has become the standard of care for the diagnosis of prostate cancer patients.This study aimed to evaluate the influence of preoperative MRI on the positive surgical margin(PSM)rates.Methods We retrospectively reviewed 1070 prostate cancer patients treated with radical prostatectomy(RP)at Siriraj Hospital between January 2013 and September 2019.PSM rates were compared between those with and without preoperative MRI.PSM locations were analyzed.Results In total,322(30.1%)patients underwent MRI before RP.PSM most frequently occurred at the apex(33.2%),followed by posterior(13.5%),bladder neck(12.7%),anterior(10.7%),posterolateral(9.9%),and lateral(2.3%)positions.In preoperative MRI,PSM was significantly lowered at the posterior surface(9.0%vs.15.4%,p=0.01)and in the subgroup of urologists with less than 100 RP experiences(32%vs.51%,odds ratio=0.51,p<0.05).Blood loss was also significantly decreased when a preoperative image was obtained(200 mL vs.250 mL,p=0.02).Multivariate analysis revealed that only preoperative MRI status was associated with overall PSM and PSM at the prostatic apex.Neither the surgical approach,the neurovascular bundle sparing technique,nor the perioperative blood loss was associated with PSM.Conclusion MRI is associated with less overall PSM,PSM at apex,and blood loss during RP.Additionally,preoperative MRI has shown promise in lowering the PSM rate among urologists who are in the early stages of performing RP.
文摘This study was designed to define possible preoperative predictors of positive surgical margin after laparoscopic radical prostatectomy. We retrospectively analyzed the records of 296 patients with prostate cancer diagnosed by prostate biopsy, and eventually treated with laparoscopic radical prostatectomy. The prognostic impact of age, prostate volume, preoperative prostate-specific antigen, biopsy Gleason score, maximum percentage tumor per core, number of positive cores, biopsy perineurat invasion, capsule invasion on imaging, and tumor laterality on surgical margin was assessed. The overall positive surgical margin rate was 29.1%. Gleason score, number of positive cores, perineural invasion, tumor laterality in the biopsy specimen, and prostate volume significantly correlated with risk of positive surgical margin by univariate analysis （P 〈 0.05）. Gleason score （odds ratio [OR] = 2.286, 95% confidence interval [95% CI] = 1.431-3.653, P= 0.001）, perineural invasion （OR = 4.961, 95% CI = 2.656-9.270, P〈 0.001）, and number of positive cores （OR = 4.403, 95% CI = 1.878-10.325, P = 0.001） were independent predictors of positive surgical margin at the multivariable logistic regression analysis. Patients with perineural invasion, higher biopsy Gleason scores and/or a large number of positive cores in biopsy pathology had more possibility of capsule invasion. The positive surgical margin rate in patients with capsule invasion （49.5%） was much higher than that with localized disease （17.8%）. In contrast, prostate volume showed a protective effect against positive surgical margin （OR = 0.572, 95% CI = 0.346-0.945, P = 0.029）. Gleason score, perineural invasion, and number of positive cores in the biopsy specimen were preoperative independent predictors of positive surgical margin after laparoscopic radical prostatectomy while prostate volume was a protective factor against positive surgical margin.
基金This research was supported by the Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Science,ICT&Future Planning(NRF-2019R1C1C1005170)Korea Health Technology R&D Project,the Korea Health Industry Development Institute(H16C2193).
文摘We investigated the relationship between positive surgical margin(PSM)-related factors and biochemical recurrence(BCR)and the ability of intraoperative frozen sections to predict significant PSM in patients with prostate cancer.The study included 271 patients who underwent robot-assisted laparoscopic prostatectomy with bilateral nerve sparing and maximal urethral preservation.Intraoperative frozen sections of the periurethra,dorsal vein,and bladder neck were analyzed.The ability of PSM-related factors to predict BCR and significant PSM was assessed by logistic regression.Of 271 patients,108(39.9%)had PSM and 163(60.1%)had negative margins.Pathologic Gleason score^8(18.9%vs 7.5%,P=0.015)and T stage≥T3a(51.9%vs 24.6%,P<0.001)were significantly more frequent in the PSM group.Multivariate analysis showed that Gleason pattern≥4(vs<4;hazard ratio:4.386;P=0.0004)was the only significant predictor of BCR in the PSM cohort.Periurethral frozen sections had a sensitivity of 83.3%and a specificity of 84.2%in detecting PSM with Gleason pattern≥4.Multivariate analysis showed that membranous urethra length(odds ratio[OR]:0.79,P=0.0376)and extracapsular extension of the apex(OR:4.58,P=0.0226)on magnetic resonance imaging(MRI)and positive periurethral tissue(OR:17.85,P<0.0001)were associated with PSM of the apex.PSM with Gleason pattern≥4 is significantly predictive of BCR.Intraoperative frozen sections of periurethral tissue can independently predict PSM,whereas sections of the bladder neck and dorsal vein could not.Pathologic examination of these samples may help predict significant PSM in patients undergoing robot-assisted laparoscopic prostatectomy with preservation of functional outcomes.
文摘Objective:No standard strategy for diagnosis and management of positive surgical margin(PSM)and local recurrence after partial nephrectomy(PN)are reported in literature.This review aims to provide an overview of the current strategies and further perspectives on this patient setting.Methods:A non-systematic review of the literature was completed.The research included the most updated articles(about the last 10 years).Results:Techniques for diagnosing PSMs during PN include intraoperative frozen section,imprinting cytology,and other specific tools.No clear evidence is reported about these methods.Regarding PSM management,active surveillance with a combination of imaging and laboratory evaluation is the first option line followed by surgery.Regarding local recurrence management,surgery is the primary curative approach when possible but it may be technically difficult due to anatomy resultant from previous PN.In this scenario,thermal ablation(TA)may have the potential to circumvent these limitations representing a less invasive alternative.Salvage surgery represents a valid option;six studies analyzed the outcomes of nephrectomy on local recurrence after PN with three of these focused on robotic approach.Overall,complication rates of salvage surgery are higher compared to TA but ablation presents a higher recurrence rate up to 25%of cases that can often be managed with repeat ablation.Conclusion:Controversy still exists surrounding the best strategy for management and diagnosis of patients with PSMs or local recurrence after PN.Active surveillance is likely to be the optimal first-line management option for most patients with PSMs.Ablation and salvage surgery both represent valid options in patients with local recurrence after PN.Conversely,salvage PN and radical nephrectomy have fewer recurrences but are associated with a higher complication rate compared to TA.In this scenario,robotic surgery plays an important role in improving salvage PN and radical nephrectomy outcomes.
文摘<strong>Background:</strong> Many patients who have had radical prostatectomy for prostate cancer may present with microscopic extraprostatic extension of the disease. Positive surgical margins are a common pathological finding in this subgroup of patients. To report the epidemiological, clinical and therapeutic aspects of PSM after radical prostatectomy (RP) and to evaluate the follow-up of patients. <strong>Patients and methods:</strong> A single-center retrospective descriptive study of patients who underwent radical prostatectomy between June 1, 2004 and December 31, 2019 was conducted. Patients who had radical prostatectomy with PSM on pathology report were included. The parameters studied were age, initial prostate specific antigen (PSA), Gleason and International Society of Uropathology (ISUP) scores, cTNM and pTNM stages, operative technique, PSA levels after surgery, adjuvant treatment and patient survival. <strong>Results:</strong> Eighty-six (86) radical prostatectomies were performed. PSM was found in 23 patients (26.7%). The mean age of the patients was 63.7 ± 6.1 years. The mean preoperative total PSA was 31.5 ng/mL (6.31 - 146 ng/mL). Prostate biopsy showed only prostatic adenocarcinoma. Thoracic-abdominopelvic CT was performed in all patients. Prostate cancers were found at the localized stage in 12 patients and locally advanced in 11 patients. A classification adjustment was obtained after pathological examination of the surgical specimen. The ISUP score 3 and 1 on the surgical specimen were in the majority with 9 and 7 patients respectively. After the recurrence, all patients who consented received hormone therapy, which was either medical with Goserelin and Triptorelin (7 patients) or surgical with testicular pulpectomy (1 patient). PSA was undetectable (<0.1 mg/mL) in 4 patients. The mean overall survival (OS) time was 28.1 months. Biological recurrence-free survival in the series was 25.7 months. <strong>Conclusion:</strong> RP with PSM is a fairly common condition that varies from less than 10% to more than 40% depending on the stage of the disease and the operators, and for which the main mean of treatment in our practice setting is hormone therapy.
基金Dr.Kerri R.Beckmann was supported by the NHMRC Early Career Researcher Fellowship(Gnt#1124210).The South Australian Prostate Cancer Clinical Outcomes Collaborative receives funding to support the Registry from the following:Movember Foundation,Urological Society of Australia and New Zealand(SA-NT Section),the Hospital Research Foundation,Mundi Pharma and Genesis Care.This funding supported the collection of data in the registry,but not this specific project.The funders had no role in the design or conduct of the studythe collection,management,analysis,and interpretation of data+1 种基金writing of the manuscriptor decision to submit for publication.
文摘Objective Positive surgical margins(PSMs)after radical prostatectomy(RP)indicate failure of surgery to completely clear cancer.PSMs confer an increased risk of biochemical recurrence(BCR),but how more robust outcomes are affected is unclear.This study investigated factors associated with PSMs following RP and determined their impact on clinical outcomes(BCR,second treatment[radiotherapy and/or androgen deprivation therapy],and prostate cancer-specific mortality[PCSM]).Methods The study cohort included men diagnosed with prostate cancer(pT2-3b/N0/M0)between January 1998 and June 2016 who underwent RP from the South Australian Prostate Cancer Clinical Outcomes Collaborative database.Factors associated with risk of PSMs were identified using Poisson regression.The impact of PSMs on clinical outcomes(BCR,second treatment,and PCSM)was assessed using competing risk regression.Results Of the 2827 eligible participants,28%had PSMs—10%apical,6%bladder neck,17%posterolateral,and 5%at multiple locations.Median follow-up was 9.6 years with 81 deaths from prostate cancer recorded.Likelihood of PSM increased with higher pathological grade and pathological tumor stage,and greater tumour volume,but decreased with increasing surgeon volume(odds ratio[OR]:0.93;95%confidence interval[CI]:0.88-0.98,per 100 previous prostatectomies).PSMs were associated with increased risk of BCR(adjusted sub-distribution hazard ratio[sHR]2.5;95%CI 2.1-3.1)and second treatment(sHR 2.9;95%CI 2.4-3.5).Risk of BCR was increased similarly for each PSM location,but was higher for multiple margin sites.We found no association between PSMs and PCSM.Conclusion Our findings support previous research suggesting that PSMs are not independently associated with PCSM despite strong association with BCR.Reducing PSM rates remains an important objective,given the higher likelihood of secondary treatment with associated comorbidities.
文摘Surgical margin is an important prognosticator in patients undergoing hepatectomy for colorectal liver metastases(CRLM)(1).However,the incidence of cut-end recurrence is relatively low,approximately 5-20%,even in patients with pathologically positive(R1)resection(1).Therefore,cut-end recurrence is not an underlying cause of poor prognosis in patients with narrow surgical margin,but it is thought to reflect tumor progression and biology(1,2).
文摘Background Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China, it is necessary to investigate the risk of positive surgical margin and biochemical recurrence, and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study, we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macao area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the proanosis of these oatients.
文摘Background:Positive surgical margins are independent risk factor for biochemical recurrence,local recurrence,and distant metastasis after radical prostatectomy.However,limited predictive tools are available.This study aimed to develop and validate a preoperative nomogram for predicting positive surgical margins after laparoscopic radical prostatectomy(LRP).Methods:From January 2010 to March 2016,a total of 418 patients who underwent LRP without receiving neoadjuvant therapy at Peking University Third Hospital were retrospectively involved in this study.Clinical and pathological results of each patient were collected for further analysis.Univariable and multivariable logistic regression(backward stepwise method)were used for the nomogram development.The concordance index(CI),calibration curve analysis and decision curve analysis were used to evaluate the performance of our model.Results:Of 418 patients involved in this study,142 patients(34.0%)had a positive surgical margin on final pathology.Based on the backward selection,four variables were included in the final multivariable regression model,including the percentage of positive cores in preoperative biopsy,clinical stage,free prostate specific antigen(fPSA)/total PSA(tPSA),and age.A nomogram was developed using these four variables.The concordance index(C-index)of the nomogram was 0.722 in the development cohort and 0.700 in the bootstrap validations.The bias-corrected calibration plot showed a limited departure from the ideal line with a mean absolute error of 2.0%.In decision curve analyses,the nomogram showed net benefits in the range from 0.2 to 0.7.Conclusion:A nomogram to predict positive surgical margins after LRP was developed and validated,which could help urologists plan surgical procedures.
文摘Objective With increased incidence of prostate cancer and an increased number of patients undergoing radical prostatectomy in China, it will be necessary to elaborate the diagnosis, clinical significance and treatment of patients whose tumors have positive surgical margins following radical prostatectomy.Data sources Positive surgical margin, prostate cancer and radical prostatectomy were used as subject words and the medical literature in recent decades was searched using the PubMed database and the results are summarized.Study selection Using positive surgical margin, prostate cancer and radical prostatectomy as subject words the PubMed medical database produced 275 papers of pertinent literature. By further screening 28 papers were selected and they represent relatively large-scale clinical randomized and controlled clinical trials.Results A pertinent literature of 275 papers was identified and 28 papers on large clinical studies were obtained. Analysis of results indicated that the positive rate of surgical margin after radical prostatectomy is 20%-40%, and although most patients with positive surgical margins are stable for a considerable period, the data available now suggested that the presence of a positive surgical margin will have an impact on the patient＇s prognosis. The risk factors of positive surgical margin include preoperative prostate specific antigen level, Gleason＇s score and pelvic lymph node metastasis. The most common site with positive surgical margin is in apical areas of the prostate; therefore surgical technique is also a factor resulting in positive surgical margins. From data available now it appears that as long as the surgical technique is skilled, different surgical modes do not affect the rate of surgical margin. Adjuvant radiotherapy is mainly used to treat patients with positive surgical margin after radical prostatectomy, but combination with androgen deprivation therapy may increase the curative effect.Conclusion The current data indicated that the presence of positive surgical margins can markedly affect the patient＇s prognosis. Therefore we should be aware how we reduce the positive surgical margin, how to diagnose positive surgical margin and how to treat when there are positive surgical margins.
文摘As for resection for colorectal liver metastasis (CRLM), secur-ing an adequate surgical margin is important for achieving a better prognosis. However, it is often difficult to achieve ade-quate margins for the resection of CRLM. So the current sur-vival impact of sub-centi/millimeter surgical margins in he-patectomy for CRLM should be evaluated. In the current era of multidisciplinary treatment options, this review focused on the prognostic impact of a sub-centi/millimeter surgical margin width in hepatectomy for CRLM. We systematically reviewed retrospective studies that clearly described the sur-gical margin width for hepatectomy for CRLM. We selected studies conducted since 2000 that involved patients diag-nosed as having CRLM. We focused on studies that investi-gated not only surgical margins, but also microscopic surgical curability such as R0 (microscopically complete resection) or R1 (microscopically incomplete resection), which clearly de-scribe their definitions. Based on our literature review, 1, 2, or 5 mm was considered the minimum surgical margin width for hepatectomy for CRLM. Although a surgical margin width of 1 mm is acceptable for hepatectomy for CRLM, submil-limeter margins, which are defined as R1 in many reports, are only acceptable for limited patients such as those who have undergone preoperative chemotherapy. Zero-mm mar-gins are also acceptable in limited patients such as those who show a good response to preoperative chemotherapy. New chemotherapy agents have been reported to reduce the prognostic impact of a narrow surgical margin width. The incidence of margin recurrence, which is a major concern regarding R1 resection of CRLM, is about 20-30% according to the majority of earlier reports. As evaluations of the actual prognostic impact of the surgical margin remain difficult, fur-ther study is warranted.
文摘Aim:One of the most important factors associated with recurrence rate and overall survival is the status of surgical margin of resection free of disease.However,sometimes,the margins measured intra-operatively at the time of surgery differ of those measured by the pathologist in the histopathologic analysis.Faced with this dilemma,a literature review of the best available evidence was conducted in an attempt to determine how the phenomenon of tissue shrinkage may influence on the surgical margin of resection in patients undergoing oral and oropharyngeal squamous cell carcinoma(SCC).Methods:An electronic and manual search was conducted by one reviewer.A combination of controlled Medical Subjects Headings and keywords were used as search strategy.Inclusion and exclusion criteria were established.Results:Finally,after an exhaustive selection process,four articles fulfilled the inclusion criteria and were analyzed.All articles reported a decrease of surgical margin after resection.The tumor site and tumor stage seem to influence in degree of margin shrinkage.Conclusion:Tissue shrinkage on surgical margins of resection in oral SCC is a tangible phenomenon.There is a significant discrepancy between margins measured intraoperatively previous to resection and margins measured by pathologist after histologic processing.The highest percentage of retraction occurs at the time of resection.Margin shrinkage based on tumor site and tumor stage should be considered by any oncologic surgeon to ensure adequate margins of resection cleared of tumor.
文摘Objective:Microscopically positive resection margins(R1)in gastric cancer have been associated with poor outcomes,but evidence regarding its prognostic significance across different stages remains inconsistent.This study investigated the impact of R1 resection on survival outcomes and evaluated the prognostic significance of detailed pathological characteristics of margin involvement.Methods:This retrospective study analyzed 10,165 patients who underwent curative-intent gastrectomy for gastric cancer between 2007 and 2021.Propensity score matching was performed at a 1:3 ratio between R1(n=45)and R0(n=130)cases.For R1 margins,detailed pathological assessment included involvement length,proportion,depth,and histological features.Survival outcomes were evaluated across all stages,and the impact of subsequent resection was analyzed.Results:After propensity score matching,R1 resection showed significantly lower 5-year overall survival rates compared to R0 resection across all stages(stageⅠ:60.0%vs.90.9%,P=0.008;stageⅡ:40.0%vs.83.3%,P=0.001;stageⅢ:20.0%vs.35.4%,P<0.001).In R1 cases,tumor involvement length≤1 cm(P<0.001),proportion≤10%(P=0.012),and mucosal-only involvement(P=0.004)were associated with better survival.Patients who underwent subsequent resection to achieve R0 status showed better survival than those with persistent R1 resection(53.8%vs.26.7%,P<0.001)and comparable survival to matched R0 cases(53.8%vs.46.9%,P=0.320).Conclusions:R1 resection significantly impairs survival across all stages of gastric cancer,with the extent and depth of microscopic involvement influencing prognosis.When R1 status is discovered postoperatively,subsequent resection should be considered to improve survival outcomes.
文摘To analyze the learning curve for cancer control from an initial 250 cases （Group I） and subsequent 250 cases （Group II） of robotic-assisted laparoscopic radical prostatectomy （RALP） performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups, Positive surgical margin （PSM） and biochemical recurrence （BCR） were assessed as cancer control outcomes. Patients in Group II had significantly more advanced prostate cancer than those in Group I （22.2% vs 14.2%, respectively, with Gleason score 8-10, P = 0.033; 12.8% vs 5.6%, respectively, with clinical stage T3, P = 0.017）. The incidence of PSM in pT3 was decreased significantly from 49% in Group I to 32.6% in Group Ih A meaningful trend was noted for a decreasing PSM rate with each consecutive group of 50 cases, including pT3 and high-risk patients. Neurovascular bundle （NVB） preservation was significantly influenced by the PSM in high-risk patients （84.1% in the preservation group vs 43.9% in the nonpreservation group）. The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased significantly after 250 cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50 cases. NVB preservation during RALP for the high-risk group is not suggested due to increasing PSM.
文摘BACKGROUND A positive resection margin is a major risk factor for local breast cancer recurrence after breast-conserving surgery(BCS).Preoperative imaging examinations are frequently employed to assess the surgical margin.AIM To investigate the role and value of preoperative imaging examinations[magnetic resonance imaging(MRI),molybdenum target,and ultrasound]in evaluating margins for BCS.METHODS A retrospective study was conducted on 323 breast cancer patients who met the criteria for BCS and consented to the procedure from January 2014 to July 2021.The study gathered preoperative imaging data(MRI,ultrasound,and molybdenum target examination)and intraoperative and postoperative pathological information.Based on their BCS outcomes,patients were categorized into positive and negative margin groups.Subsequently,the patients were randomly split into a training set(226 patients,approximately 70%)and a validation set(97 patients,approximately 30%).The imaging and pathological information was analyzed and summarized using R software.Non-conditional logistic regression and LASSO regression were conducted in the validation set to identify factors that might influence the failure of BCS.A column chart was generated and applied to the validation set to examine the relationship between pathological margin range and prognosis.This study aims to identify the risk factors associated with failure in BCS.RESULTS The multivariate non-conditional logistic regression analysis demonstrated that various factors raise the risk of positive margins following BCS.These factors comprise non-mass enhancement(NME)on dynamic contrastenhanced MRI,multiple focal vascular signs around the lesion on MRI,tumor size exceeding 2 cm,type III timesignal intensity curve,indistinct margins on molybdenum target examination,unclear margins on ultrasound examination,and estrogen receptor(ER)positivity in immunohistochemistry.LASSO regression was additionally employed in this study to identify four predictive factors for the model:ER,molybdenum target tumor type(MT Xmd Shape),maximum intensity projection imaging feature,and lesion type on MRI.The model constructed with these predictive factors exhibited strong consistency with the real-world scenario in both the training set and validation set.Particularly,the outcomes of the column chart model accurately predicted the likelihood of positive margins in BCS.CONCLUSION The proposed column chart model effectively predicts the success of BCS for breast cancer.The model utilizes preoperative ultrasound,molybdenum target,MRI,and core needle biopsy pathology evaluation results,all of which align with the real-world scenario.Hence,our model can offer dependable guidance for clinical decisionmaking concerning BCS.
基金supported by the National Natural Science Foundation of China(Grant Nos.82272955 and 22203057)the Natural Science Foundation of Fujian Province(Grant No.2021J011361).
文摘The presence of a positive deep surgical margin in tongue squamous cell carcinoma(TSCC)significantly elevates the risk of local recurrence.Therefore,a prompt and precise intraoperative assessment of margin status is imperative to ensure thorough tumor resection.In this study,we integrate Raman imaging technology with an artificial intelligence(AI)generative model,proposing an innovative approach for intraoperative margin status diagnosis.This method utilizes Raman imaging to swiftly and non-invasively capture tissue Raman images,which are then transformed into hematoxylin-eosin(H&E)-stained histopathological images using an AI generative model for histopathological diagnosis.The generated H&E-stained images clearly illustrate the tissue’s pathological conditions.Independently reviewed by three pathologists,the overall diagnostic accuracy for distinguishing between tumor tissue and normal muscle tissue reaches 86.7%.Notably,it outperforms current clinical practices,especially in TSCC with positive lymph node metastasis or moderately differentiated grades.This advancement highlights the potential of AI-enhanced Raman imaging to significantly improve intraoperative assessments and surgical margin evaluations,promising a versatile diagnostic tool beyond TSCC.
文摘BACKGROUND Fibroadenomas(FA)and phyllodes tumors(PT)are fibroepithelial neoplasms and are difficult to differentiate radiographically and histologically.We present a partially infarcted borderline PT in an adolescent with rapid tumor enlargement within 24 hours.Tumor infarction made the diagnostic work-up difficult.Com-plete surgical excision is the standard of care for PTs.There is controversy regar-ding margin re-excision for borderline PTs.In this report,we discuss the diagno-stic challenges of PT and the evolving concept of margin status on PT recurrence rate.CASE SUMMARY A 14-year-old healthy female with no medical history presented with a painful right breast mass with no nipple discharge,trauma,or skin findings.The mass showed rapid enlargement over 24 hours,prompting a workup with ultrasound and core needle biopsy.The initial biopsy was limited due to large areas of in-farction.Based on the scant viable tissue and considering the patient’s age,the mass was favored to be a juvenile FA.The patient underwent excision of the mass.Final pathology confirmed a borderline PT with positive surgical margins.The patient underwent margin re-excision,which did not show any residual tumor.At the 6-month post-op visit,there was a mass-forming lesion on the breast ultrasound.Subsequent core needle biopsy showed benign breast parenchyma with scar formation.The primary goal of evaluation in pediatric breast masses is to do no harm.However,rapidly growing and symptomatic masses require a more extensive work-up including biopsy and surgical excision.We present a rapidly growing breast mass in a 14-year-old female which was diagnosed as a borderline PT on her excision specimen.The mass rapidly enlarged over 24 hours.The initial biopsy pathology was limited due to a large area of infarction.The patient underwent excision of the mass.Final pathology confirmed a borderline PT that extended into the surgical margin,resulting in an additional re-excision procedure.Accurate diagnosis prior to surgical intervention is crucial to avoid additional procedures.Although histological morphology remains the gold standard for diagnosis,immunohistochemistry and molecular studies have recently shown to improve the accuracy of diagnosis of PTs.Long-term clinical and pathologic follow-up of PTs in adolescent patients should be collectively studied to examine whether our current diagnostic criteria for PT can reliably predict tumor behavior in this age group.CONCLUSION Accurate diagnosis of PTs requires surgical excision.Tumor infarction may lead to rapid tumor enlargement,hindering the correct diagnosis.More research is needed on margin status and recurrence rate,especially in adolescent patients,to help establish the best possible care for this age group.
基金supported by the Interdepartmental Research Project of Peking University First Hospital(No.2023IR27 to Liu Y)the Scientific Research Seed Fund of Peking University First Hospital(No.2023SF40 to Qiu J)+3 种基金the High Quality Clinical Research Project of Peking University First Hospital(No.2022CR75 to Gong K)the Beijing Natural Science Foundation(No.QY23068 to Deng R)the National Natural Science Foundation of China(No.82141103,No.82172617,and No.81872081 to Gong K)the Capital’s Funds for Health Improvement and Research(No.2022-2-4074 to Gong K).
文摘Objective:To explore clinicopathological predictors of adverse pathological changes(APCs)(upgrading,upstaging,and positive surgical margin[PSM])after robot-assisted radical prostatectomy(RARP)in clinical tumor stage 2c(cT2c)prostate cancer(PCa)patients.Methods:From January 2018 to December 2022,cT2cN0M0 PCa patients who underwent prostate biopsies and subsequent RARP at the Peking University First Hospital with an interval between biopsy and RARP of ≤90 days were included.Univariable and stepwise multivariable logistic regression analyses were performed to identify independent risk factors associated with APCs.Nomograms were constructed based on these predictive models.The performance of the nomograms was evaluated by receiver operating characteristic curves,decision curve analyses,and calibration plots.Results:A total of 423 eligible cT2cN0M0 PCa patients were included.The rates of upgrading,upstaging,and PSM in our cohortwere 33%,51%,and 35%,respectively.The stepwise multivariate logistic analysis suggested that PSA density and the percentage of positive cores in systematic biopsy were significantly associated with the occurrence of APCs.The score of the Prostate Imaging Reporting and Data System,PSA density,and the International Society of Urological Pathology grade group(IGG)of needle-biopsy specimens(or clinical IGG[cIGG])were significantly associated with upgrading.The PSA density,percentage of positive cores in systematic biopsy,and largest tumor percentage in all cores of each patient(LTP)were significantly associated with upstaging.The PSA density and LTP were significantly associatedwith the PSM.Based on these results,four nomogramswere developed.Receiver operating characteristic curves,decision curve analyses,and calibration plots implied that the nomograms exhibited excellent accuracy.Conclusion:The predictive models we developed could help to identify high-risk PCa early,and optimize clinical decisions of cT2cN0M0 PCa patients.
基金The National Key Research and Development Program of China,No.2016YFC0106004.
文摘BACKGROUND The long-term effect of anatomic resection(AR)is better than that of nonanatomic resection(NAR).At present,there is no study on microvascular invasion(MVI)and liver resection types.AIM To explore whether AR improves long-term survival in patients with hepatocellular carcinoma(HCC)by removing the peritumoral MVI.METHODS A total of 217 patients diagnosed with HCC were enrolled in the study.The surgical margin was routinely measured.According to the stratification of different tumor diameters,patients were divided into the following groups:≤2 cm group,2-5 cm group,and>5 cm group.RESULTS In the 2-5 cm diameter group,the overall survival(OS)of MVI positive patients was significantly better than that of MVI negative patients(P=0.031).For the MVI positive patients,there was a statistically significant difference between AR and NAR(P=0.027).AR leads to a wider surgical margin than NAR(2.0±2.3 cm vs 0.7±0.5 cm,P<0.001).In the groups with tumor diameters<2 cm,both AR and NAR can obtain a wide surgical margin,and the surgical margins of AR are wider than that of NAR(3.5±5.8 cm vs 1.6±0.5 cm,P=0.048).In the groups with tumor diameters>5 cm,both AR and NAR fail to obtain wide surgical margin(0.6±1.0 cm vs 0.7±0.4 cm,P=0.491).CONCLUSION For patients with a tumor diameter of 2-5 cm,AR can achieve the removal of peritumoral MVI by obtaining a wide incision margin,reduce postoperative recurrence,and improve prognosis.
文摘Since the first report on laparoscopic distal pancreatectomy (LDP) appeared in the 1990s, the procedure has been performed increasingly frequently to treat both benign and malignant lesions of the pancreas. Many earlier publications have shown LDP to be a good alternative to open distal pancreatectomy for benign lesions, although this has never been studied in a prospective, randomized manner. The evidence for the use of LDP to treat adenocarcinoma of the pancreas is not as well established. The purpose of this review is to evaluate the current evidence for LDP in cases of pancreatic adenocarcinoma. We conducted a review of English language publications reporting LDP results between 1990 and 2013. All studies reporting results in patients with histologically proven pancreatic adenocarcinoma were included. Thirty-nine publications were found and included in the results for a total of 309 cases of pancreatic adenocarcinoma (potential double publications were not eliminated). Most LDP procedures are performed in selected cases and generally involve smaller tumors than open distal pancreatectomy (ODP) procedures. Some of the papers report unselected cases and include procedures on larger tumors. The number of lymph nodes harvested using LDP is comparable to the number obtained with ODP, as is the frequency of R0 resections. Current data suggest that similar short term oncological results can be obtained using LDP as those obtained using ODP.
