Risk factors for positive resection margins after endoscopic submucosal dissection of early esophageal squamous carcinomas and precancerous lesions / 中华消化内镜杂志

Objective To identify the risk factors for positive resection residues after endoscopic submucosal dissection ( ESD ) of early esophageal squamous carcinomas and precancerous lesions. Methods A retrospective analysis was performed in 315 patients with early esophageal squamous cancer and precancerous lesion who underwent ESD. The pathological features of all resection margins in the specimen and the follow?up outcome of the patients with positive resection margin were evaluated. Univariate and multi?variate analysis were used to determine the risk factors for resection margin residues after ESD. Results In 315 lesions,there were 290 lesions with negative resection margins and 25 with positive resection margins.The number of lesions with positive lateral, basal, or both resection margins was 13, 8, and 4, respectively. Multivariate analysis showed that the depth of invasion( submucosal layer invasion, P=0?048) was the only independent risk factor for positive basal resection margin. The proportion of circumferential extension (≥3/4,P=0?014) and the depth of invasion( exceeding muscularis mucosa, P=0?007) were independent risk factors for positive lateral resection margin. Conclusion The diameter of the lesions and the depth of tumor invasion are independent risk factors for esophageal ESD positive resection margins. Accurate evaluation of lesion extension and invasive depth is critical to avoid residual or recurrent tumor after esophageal ESD.

Application of preoperative MRI on breast cancer patients undergoing breast-conserving surgery / 实用放射学杂志

Objective To evaluate the influence of preoperative MRI on tumor-positive rate of resection margins in breast cancer patients eligible for breast-conserving surgery.Methods Study group consisted of 64 consecutive patients with breast cancer eligible for breast-conserving surgery,while 73 cases as history control group.For the two groups,a first plan for breast-conserving surgery was made on the basis of conventional imaging and clinical evaluation.Study group underwent preoperative breast MRI and re-evalu-ated before final surgical plan was made.Rates of tumor-positive resection margins were compared between the 2 groups.Surgical plan alteration was recorded in the study group.Results Study group had lower rate of tumor-positive resection margin compared with control group (9.6% vs 24.7%,P =0.04).Furthermore,18.8% of study group altered the finial surgical plan to mastectomy after breast MRI.Conclusion Preoperative breast MRI can more acurately evaluate the extent of breast cancer,therefore decrease rate of tumor-positive resection margin in breast cancer patients eligible for breast-conserving surgery.

Clinical Outcome of Positive Margin of Postgastrectomy with Adenocarcinoma of Stomach / 고신대학교의과대학학술지

OBJECTIVES: Many investigators have recommended adequate resection margin and lymphadenectomy for radical curative resection. The aim of this study is to evaluate clinical characteristics of positive resection margin (proximal or distal) of postgastrectomy in advanced gastric cancer. METHODS: We studied 17 patients with gastric cancer who were diagnosed positive resection margin by intraoperative frozen biopsy or permanent biopsy report from January 2005 to December 2007, retrospectively. Surgical margin monitored by endoscopy. RESULTS: Distal gastrectomy was performed in 13 patients and total gastrectomy in 4. Gastrectomy with combined resection including splenectomy was performed in 3, distal pancreatectomy in 2, transverse colon segmental resection in 1, and cholecystectomy in 2. Positive Proximal margin was found in 12, positive distal margin in 3, and both in 2. Palliative chemotherapy was performed in 8 patients. Postoperative follow up endoscopy was established in only 8 patients. Malignant results from endoscopic biopsy in gastroenteric or esophagoenteric anastomotic line were proven in 2 patients during follow up. 9 patients were not performed follow-up endoscopy. Among total 17 patients, 2 patients are alive. Fifteen patients died of aggravation of disease in 13 and postoperative complication in 2. CONCLUSIONS: Although positive surgical margin in far advanced gastric cancer were found, it can consider that does not further resection to obtain microscopic clear anastomotic margin.

Clinical and Histopathological Analysis of Reoperation Cases in Breast Conserving Surgery

PURPOSE: The residual microscopic carcinoma after breast conserving surgery is the most important risk factor of local recurrence. As local recurrences usually develop around resected margins, it is ge nerally accepted that every effort should be made to achieve negative margins intraoperatively, and the presence of microscopically positive margins requires reexcision. Interestingly, sizable percentage of reexcisions results in a specimen free of residual tumor, and may not contribute to disease control, but do add morbidity, cost, and possibly compromise cosmetic result. The goal of our study was to identify which clinico-pathologic factors were associated with positive resection margin, and to identify the variables associated with no residual carcinoma on reexcision or total mastectomy specimens. METHODS: From Sepember 1994 to July 1999, 322 breast conserving surgery were performed on breast cancer patients at the Department of General Surgery, Samsung Medical Center. Among them, 13 patients had positive surgical margins and were treated with reexcision (reexcising the previous lumpectomy cavity with a margin of 1-2 cm of normal tissue) or total mastectomy. RESULTS: The factors associated with positive resection margins were large tumor size, the presence of extensive intraductal component (EIC), and suspicious mammographic microcalcifications without mass density. Six (46.3%) of these reoperation cases for positive margins were negative for residual tumor. The factors correlating with no residual carcinoma on reexcision or mastectomy specimens were small histologic primary tumor size and only one positive resection margin rather than 2 or more positive margins. CONCLUSION: The patients with above-mentioned factors associated with positive resection margins should be treated with more wide local excision or total mastectomy to avoid a second surgical procedure. If the patients with only one positive margin and small tumor size refuse second operation, they could be treated with irradiation only sparing an additional surgical procedure.