Search

Introduction Surgical management of skin cancer is an important part of modern maxillofacial surgery. The common tumours treated are squamous cell carcinoma, malignant melanoma and some benign lesions, but the largest group of tumours are the basal cell carcinomas. Although only locally aggressive, if they are not completely removed, recurrence may occur and be troublesome, especially in the head and neck. Even in this region, incomplete excision is uncommon, less than 20 %, but management of positive margins remains controversial. This review evaluates the effectiveness of a further surgical intervention after a positive margin. Materials and methods A retrospective audit was undertaken to determine the rate of positive margins within the unit and subsequently the percentage of residual tumour found in any secondary excisions. Results The results show that in a sample of 247 patients, 11 % had positive peripheral margins. A second excision only showed that 36 % had any evidence of residual tumour. Discussion The study raises the question of the value of further surgery. Finally, the authors suggest a more focused approach to the finding of a positive margin before the patient is offered more treatment.

Objective To assess potential biases, such as the reporting pathologist, that may affect objectivity of T2 positive margin rates as a quality outcome measure following radical prostatectomy. Patients and methods Prospective data on 183 consecutive LRP patients with pT2 disease, operated on by a single surgeon (2003–2009), were studied. Outcomes were grouped as pre-, peri-, and post-operative and included: age, ethnicity, Gleason score, reporting pathologist, percentage of positive cores, operative time, blood loss, nerve-sparing status, hospital stay and prostate weight. Descriptive analysis and logistic regression analysis were carried out to compare these variables by positive margin status. Results A total of 30 (16.4 %) positive surgical margins (PSMs) were reported. Surgical stage, earlier date of surgery, and lower prostatic weight showed statistically significant associations with PSM status in both univariate and multivariate analysis. The reporting pathologist was not found to be predictive of PSMs (P = 0.855). Conclusion We showed that the reporting pathologist does not influence T2 positive margin status, in contrast to tumour characteristics and surgeon experience. T2 positive margin assessment therefore appears to be an objective quality outcome measure.

• The charts of patients treated surgically for squamous cell carcinoma of the head and neck were reviewed retrospectively to correlate the pathologic report of the adequacy of margins with subsequent treatment and eventual outcome. Three hundred forty-nine patients were studied. Thirty-one patients (8.8%) had positive margins. Positive margins were most commonly encountered in patients with tonsillar and hypopharyngeal lesions. Twenty-nine (94%) of the patients had stage III or IV disease. Two patients (6.4%) remain free of disease 36 months or longer following surgery. Radiation therapy was administered postoperatively to 25 patients. Sixty percent of these patients failed to achieve local-regional control, and 84% are dead of disease. When free margins of resection cannot be obtained due to anatomic limitation, postoperative radiation therapy has been unsatisfactory in our hands. Alternative treatment, such as radiation implants or chemotherapy, would appear to offer the only hope of improving the chances for long-term survival. ( Arch Otolaryngol Head Neck Surg 1986;112:863-866)

Many patients who undergo total prostatectomy for clinically localized disease will be found to have local tumor extension beyond the prostate following microscopic examination of the surgical specimen (pathological Stage C). Many of these patients are at increased risk for local and distant recurrence, and an effective form of adjuvant therapy is desirable. Several investigators over the years have utilized adjuvant radiation therapy in this setting with a demonstrated decrease in local recurrence. There has been no significant improvement in survival however. This could represent the fact that those patients who have distant progression most likely had subclinical distant disease present at the time of the radiation, and because the follow-up in most series remains short, there has yet been no significant difference in survival. Most series do indicate a trend toward improved survival in the patients who received adjuvant radiation therapy, suggesting that with time, as the subpopulation of patients who only had residual local disease—now controlled with radiation—survive longer, there will also be a survival advantage.

The main curative treatment for localized colon cancer is surgical resection. However when tumor residuals are left positive margins are found during the histological examinations and additional treatment is needed to inhibit recurrence. Hyperspectral imaging (HSI) can offer non-invasive surgical guidance with the potential of optimizing the surgical effectiveness. In this paper we investigate the capability of HSI for automated colon cancer detection in six ex-vivo specimens employing a spectral-spatial patch-based classification approach. The results demonstrate the feasibility in assessing the benign and malignant boundaries of the lesion with a sensitivity of 0.88 and specificity of 0.78. The results are compared with the state-of-the-art deep learning based approaches. The method with a new hybrid CNN outperforms the state-of the-art approaches (0.74 vs. 0.82 AUC). This study paves the way for further investigation towards improving surgical outcomes with HSI.

Positive margins and the resulting multiple operations are a major problem for breast conservation therapy. Accurate assessment of intraoperative tumor margins can limit multiple re-excision procedures. Intraoperative touch preparations have been used in the past but can be difficult to interpret without an experienced cytopathologist. The objective of this study is to examine the reliability of enhanced intraoperative touch preps (EIOTP) compared with final pathologic margins. We prospectively performed EIOTP on 20 tumors in women undergoing breast conservation therapy. Six margins and the main tumor were touched onto poly-L-lysine coated slides. The slides were stained with anti MUC1 and anti-E-cadherin antibodies, and Hoechst nuclear stain. A parallel set of slides were stained with hematoxylin and eosin for comparison. The EIOTP results were compared with pathologic interpretation of paraffin embedded permanent sections. A total of 120 margins underwent EIOTP in 20 patients. We found a sensitivity equal to 80 per cent, specificity 100 per cent, positive predictive value 100 per cent, and negative predictive value 99 per cent. EIOTP in conjunction with MUC-1 and E-cadherin by immunofluorescence is a sensitive and highly specific mechanism to identify cancer cells at breast tissue margins. The immunofluorescence stains may help the pathologist to identify cancer cells in fresh breast tissue and limit breast re-excisions in the future.