RESUMO
Since the observation that clearance of all visible and microscopic tumors from cutaneous melanoma is critical to prevent a recurrence, wide surgical margins have been central to surgical dogma. In the last several decades, more conservative margin widths have been vigorously studied by surgical investigators to lessen wound complications, the need for reconstruction, and healthcare costs. This review summarizes surgeon-led clinical trials that define current guidelines and highlights the challenges to initiate and perform trials today.
Assuntos
Ensaios Clínicos como Assunto/métodos , Procedimentos Cirúrgicos de Citorredução/métodos , Melanoma/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Neoplasias Cutâneas/cirurgia , Ensaios Clínicos como Assunto/história , Ensaios Clínicos como Assunto/normas , Procedimentos Cirúrgicos de Citorredução/história , Procedimentos Cirúrgicos de Citorredução/normas , História do Século XX , História do Século XXI , Humanos , Margens de Excisão , Melanoma/história , Melanoma/patologia , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto/história , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Neoplasias Cutâneas/história , Neoplasias Cutâneas/patologia , Melanoma Maligno CutâneoRESUMO
Joe V. Meigs was a visionary clinician and an early adopter of radical techniques in the surgical treatment of ovarian cancer. His 1934 textbook "Tumors of the Female Pelvic Organs", consolidated his approach to this "hopeless" disease, with pearls on diagnosis, outcomes, and even speculations about the benefits of minimally invasive surgery. Decades before adjuvant chemotherapy would prove of value, and in an era when sophisticated statistics were unheard of, he nonetheless tried to eke out what benefits he could using the methods available in his time. We transition his original findings and observations through the advent of platinum-based chemotherapy, retrospective cohort studies supporting the benefits of primary debulking, and finally the long-awaited randomized controlled trial. We aim to provide historical context for the underpinnings of how cytoreductive surgery has evolved into its current role in the treatment of advanced ovarian cancer.
