Disease-free Margins Research Articles

Epidemiological landscape of tongue cancer in younger patients in a National Cancer Center in Brazil

This study investigates the changing epidemiological profile of tongue squamous cell carcinoma (SCC) to young patients, highlighting its rising incidence among non-traditional risk groups. A retrospective descriptive study was conducted, covering data from medical records between 2000 and 2012. Patients were categorised into two age groups (≤ 40 years; 41–50 years). Sociodemographic and clinicopathological characteristics were evaluated. A total of 108 patients participated, mostly aged 41–50. Alcohol consumption (43.3%) surpassed smoking. Majority (56.7%) aged ≤ 40 never smoked. Lateral tongue border was most affected, with stages III and IV prevalent. Patients aged ≤ 40 were mostly eligible for surgery (44%). Survival tied to staging and surgery; age had no significant impact. Young squamous cell carcinoma patients often lacked traditional risk factors like smoking, underwent surgery, and typically had disease-free margins. The study underscores the importance of broad external policies for early diagnosis, beyond just traditional risk groups.

Three-Dimensional Imaging-Guided Lung Anatomic Segmentectomy: A Single-Center Preliminary Experiment.

Background and objectives: VATS segmentectomy has been proven to be effective in the treatment of stage I NSCLC, but its technical complexity remains one of the most challenging aspects for thoracic surgeons. Furthermore, 3D-CT reconstruction images can help in planning and performing surgical procedures. In this paper, we present our personal experience of 11 VATS anatomical resections performed after accurate pre-operative planning with 3D reconstructions. Materials and methods: A 3D virtual model of the lungs, airways, and vasculature was obtained, starting from a 1.25 mm 3-phase contrast CT scan, and the original images were used for the semi-automatic segmentation of the lung parenchyma, airways, and tumor. Results: Six males and five females were included in this study. The median diameter of the pulmonary lesion at the pre-operative chest CT scan was 20 mm. The surgical indication was confirmed in seven patients: in three cases, a lobectomy, instead of a segmentectomy, was needed due to intraoperative findings of nodal metastasis. Meanwhile, only in one case, we performed a lobectomy because of inadequate surgical resection margins. Skin-to-skin operative average time was 142 (IQR 1-3 105-182.5) min. The median post-operative stay was 6 (IQR 1-3 3.5-7) days. The mean value of the closest surgical margin was 13.7 mm. Conclusion: Image-guided reconstructions are a useful tool for surgeons to perform complex resections in order to spare healthy parenchyma and to ensure disease-free margins. Nevertheless, human skill and surgeon experience still remain fundamental for the final decisions regarding the proper resection to perform.

Improved Rate of Negative Margins for Inflammatory Breast Cancer Using Intraoperative Frozen Section Analysis.

Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer with a poor survival rate. Modified radical mastectomy (MRM) with negative pathologic margins is critical for improved survival. We aim to study the potential benefit of intraoperative frozen section analysis (FSA) to improve disease-free margins. This prospective, monocentric study included 19 patients who underwent MRM for IBC. For each patient, a 2 mm continuous skin edge was sent for FSA to guide further resection. The rate of tumor-free margins and the concurrence between the FSA and permanent pathological results were analyzed. Overall, 15 of the 19 patients achieved negative margins, including four patients who would have had positive margins without FSA. The odds ratio of achieving a negative final margin with FSA was infinity (p = 0.031), and there was a strong agreement between the FSA and permanent pathological results (Kappa-0.83; p < 0.0001). The FSA technique decreased the number of positive margins in IBC patients undergoing MRM, thereby potentially reducing the need for re-operation, allowing immediate wound closure, and preventing delays in the administration of adjuvant radiation therapy. More extensive trials are warranted to establish the use of intraoperative FSA in IBC treatment.

Survival variability across hospitals after resection for pancreatic adenocarcinoma: A multilevel survival analysis on a high-resolution population-based study

IntroductionResection is the cornerstone of curative management for pancreatic ductal adenocarcinoma (PDAC). Hospital surgical volume influence post-operative mortality. Few is known about impact on survival. MethodsPopulation included 763 patients resected for PDAC within the 4 French digestive tumor registries between 2000 and 2014. Spline method was used to determine annual surgical volume thresholds influencing survival. A multilevel survival regression model was used to study center effect. ResultsPopulation was divided into three groups: low-volume (LVC) (<41 hepatobiliary/pancreatic procedures/year), medium-volume (MVC) (41–233) and high-volume centers (HVC) (>233). Patients in LVC were older (p = 0.02), had a lower rate of disease-free margins (76.7% vs. 77.2% and 69.5%, p = 0.028) and a higher post-operative mortality than in MVC and HVC (12.5% and 7.5% vs. 2.2%; p = 0.004). Median survival was higher in HVC than in other centers (25 vs. 15.2 months, p < 0.0001). Survival variance attributable to center effect accounted for 3.7% of total variance. In multilevel survival analysis, surgical volume explained the inter-hospital survival heterogeneity (non-significant variance after adding the volume to the model p = 0.3). Patients resected in HVC had a better survival than in LVC (HR 0.64 [0.50–0.82], p < 0.0001). There was no difference between MVC and HVC. ConclusionRegarding center effect, individual characteristics had little impact on survival variability across hospitals. Hospital volume was a major contributor to the center effect. Given the difficulty of centralizing pancreatic surgery, it would be wise to determine which factors would indicate management in a HVC.

Accuracy of cone-beam computed tomography, digital mammography and digital breast tomosynthesis for microcalcifications and margins to microcalcifications in breast specimens

Accurate determination of resection margins in breast specimens is important as complete removal of malignancy is a prerequisite for patients’ outcome. Mammography (DM) as 2D-technique provides only limited value in margin assessment. Therefore, we investigated whether cone-beam computed tomography (CBCT) or digital breast tomosynthesis (DBT) has incremental value in assessing margins to microcalcifications. Three independent readers investigated breast specimens for presence of microcalcifications and the smallest distance to margins. Histopathology served as gold standard. Microcalcifications were detected in 15 out of 21 included specimens (71%). Pooled sensitivity for DM, DBT and CBCT for microcalcifications compared to preoperative DM was 0.98 (CI 0.94–0.99), 0.83 (CI 0.73–0.94) and 0.94 (CI 0.87–0.99), pooled specificity was 0.99 (CI 0.99–0.99), 0.73 (CI 0.51–0.96) and 0.60 (CI 0.35–0.85). Mean measurement error for margin determination for DM, DBT and CBCT was 10 mm, 14 mm and 6 mm (p = 0.002) with significant difference between CBCT and the other devices (p < 0.03). Mean reading time required by the readers to analyze DM, DBT and CBCT, was 36, 43 and 54 s (p < 0.001). Although DM allows reliable detection of microcalcifications, measurement of resection margin was significantly more accurate with CBCT. Thus, a combination of methods or improved CBCT might provide a more accurate determination of disease-free margins in breast specimens.

Preoperative localisation of nonpalpable breast lesions using magnetic markers in a tertiary cancer centre

BackgroundWe retrospectively evaluated safety and performance of magnetic seed localisation of nonpalpable breast lesions.MethodsWe reviewed records of patients with nonpalpable breast lesions preoperative localised by placing magnetic Magseed® marker between February 2019 and December 2020. During surgery, Sentimag® magnetic probe was used to localise the marker and guide surgery. Safety, lesion identification and excision with tumour with free margins and re-excision rate were assessed.ResultsA total of 77 Magseed® devices were placed into the breasts of 73 patients, 44 under ultrasound and 33 under stereotactic guidance (4 bilateral). All devices were retrieved as were the target lesions. Magnetic marker placement was successful in all cases without any adverse event. Intraoperative identification and excision of the localised lesion were successful in 77 of 77 of cases (100%). In three cases (all of them calcifications with the seed placed under stereotactic guidance), the seed did not reach the exact target position of the biopsy clip; thus, larger excision was needed, with localisation failure attributed to incorrect clip insertion (n = 1) or to clip dislocation (n = 2). Migration of the marker was negligible in all patients. Complete excision after the initial procedure with at least 1-mm disease-free margins was obtained in 74 out of 77 (96.1%) lesions. The re-excision rate was 3 out of 77 (4%).ConclusionsMagnetic marker localisation for nonpalpable breast lesions was safe, reliable, and effective in terms of lesion identification, excision with tumour-free margins and re-excision rate.

Intraoperative assessment of surgical margins using “en face” frozen sections in the management of cutaneous carcinomas

BackgroundBasal cell and squamous cell carcinomas (BCC and SCC) are the most common types of cancer worldwide. Intraoperative assessment of surgical margins by frozen section has been widely used to ensure disease-free margins. The intraoperative “en face” freezing technique evaluates all peripheral and deep margins. ObjectiveTo report the results of the “en face” freezing technique in relation to tumor recurrence and agreement with paraffin-embedded tissue examination. MethodsRetrospective analysis of patients undergoing surgical excision of BCC and SCC at the A. C. Camargo Cancer Center, Brazil. ResultsThis study included 542 skin carcinomas, which were excised from 397 patients. A total of 201 male patients (50.6%), and 196 female patients (49.4%) were assessed, whose mean age was 64 years. The tumors were mostly located on the head and neck region (87.8%). BCC corresponded to 79.7% of the cases. The mean follow-up was 38 months. Tumor relapse occurred in 0.86% of the primary tumors and 3.7% of recurrent tumors. The result of the intraoperative “en face” frozen section evaluation was in agreement with the final result of the anatomopathological examination (paraffin test) in 98% of the lesions. Study limitationsNot having a minimum follow-up time of 5 years for all patients. ConclusionThe “en face” freezing technique shows low tumor relapse, being reliable and safe to guarantee negative surgical margins of the tumor.

Laparoscopic Colon Resection

Background: Laparoscopic surgery has a well-documented role in colon resection with improved postoperative outcomes even in low-volume centers. Recently, we have integrated minimally invasive laparoscopic resection, followed by the enhanced recovery after surgery (ERAS) protocol, to improve postoperative outcomes in our hospital. Objectives: To review our experience of laparoscopic colonic resection with the ERAS protocol and compare our outcomes with those in the literature. Design: Observational retrospective. Setting: Governmental tertiary hospital. Materials (Patients) and Methods: Data of patients over 18 years of age who had undergone laparoscopic colonic resection between January 2016 and December 2021 were retrospectively obtained from medical records. Patients with trauma-related injuries were excluded. The variables collected included patient demographics, disease information, operative and postoperative data, and histopathological reports. Data were compared with similar published studies and landmark trials. Sample Size: 92 patients. Main Outcome Measures: Rates of conversion to open procedure, number of lymph nodes harvested, hospital length of stay, percentage of positive margins, 30-day morbidity, and 30-day mortality. Results: During the study period, 92 patients (59% men) underwent laparoscopic colon resections, of which eight (8.6%) required an open procedure. The average operative time was 233 minutes, and the average intraoperative blood loss was 78 mL. Intraoperative complications occurred in four cases with no postoperative sequelae. The median length of hospital stay was 5 days. Malignant specimens revealed 100% disease-free margins with an average of 22 lymph nodes harvested. The postoperative 30-day morbidity, mortality, and histopathological results were comparable with landmark trials. Conclusion: As a new technique in a low-volume center, laparoscopic colon resection was challenging. Despite the presence of an experienced laparoscopic surgeon, extensive training was required to safely complete the procedure within a reasonable operative time with a successful outcome. Furthermore, the implementation of the ERAS protocol was difficult; however, the team mastered it after the first few cases. This study showed that both efficacy and safety can be achieved in laparoscopic colon resections in low-volume centers. Moreover, the ERAS protocols can be implemented; however, their implementation will require additional training, which may lead to better outcomes. Limitations: The lack of general surgery wards in a busy tertiary trauma center meant that patients with variable wound contamination would share the same unit. Conflict of Interest Statement: None. Number of similar cases published: N/A.

LARGE PERIOCULAR DEFECTS RECONSTRUCTION WITH AXIAL AND RANDOM PATTERN FLAPS. INDICATIONS, TECHNIQUE DESCRIPTION AND FOLLOW-UP ON OCCASION OF 4 CASES

​INTRODUCTION: Large periocular defects have always been a reconstructive challenge in terms of viability, cosmesis and functionality. Their vicinity with important anatomical structures makes reconstruction difficult to plan and the surgeon should take into account several alternatives. AIM: Our aim is the presentation of techniques performed on our department patients. Four intendedly different cases treated with respective flaps are documented preoperatively, postoperatively and in the follow-up period. MATERIAL – METHODS: 4 Patients (2 male and 2 female) with cutaneous malignancies concerning: the inner canthal ligament area (1), the nasal flank and lower eyelid (1) and the lower tarsal plate (2). 1 inferiorly based advancement nasolabial flap, 2 Mustardé flaps and 1 Tenzel flap were performed. The mean age of the patients was 85,75 y.o. (range from 77 to 96). RESULTS: All four patients had disease-free margins of excision and no recurrence at all. We avoided composite approaches with concern to their age and general condition. No complications were mentioned (including necrosis of the flap, wound dehiscence or infection). The esthetic result is judged fair (1 patient), good (1 patient), very good (2 patients). In the follow-up period, one patient presented mild epiphora and another mild corneal exposure. One patient being planned to undergo a differed correction postponed his treatment. CONCLUSION: Meticulously designed traditional flaps such as V-Y advancement flap, Mustardé flap and Tenzel flap can offer an acceptable outcome balanced between functionality and cosmetic result on the one hand and lessening complications on the other.

Transanal Local Excision or Endoscopic Dissection for Benign and Large Lesions of the Rectum.

Since the introduction of transanal endoscopic microsurgery, local excision of "early" rectal lesions has offered the possibility to reduce the invasiveness of treatment for the limited disease. Flexible endoscopy techniques allow today different alternatives consisting of endoscopic mucosal resection or endoscopic submucosal dissection. The first is a straightforward and relatively easy technique, but it prevents a correct pathological staging of the lesion due to fragmentation and the verification of disease-free margins. The second relies on operators' audacity depending on their increasing experience due to the limited progress in technology. What is the preferable technique today is questionable. All the methods have pros and cons. The future certainly will see the use of ideal systems, allowing the possibility of precision surgery for partial- or full-thickness excision, depending on intraoperative findings, and the extension above the rectosigmoid junction. Miniaturized flexible robotic devices may represent the solution for both issues.

Clinical Outcome of Breast Conservation Surgery in Early Breast Cancer Patients: A Prospective Interventional Study

Introduction: Breast conservation surgery (BCS) has gained acceptance among the surgeons for the management of young patients with early breast cancer. Aim: To study the outcomes of breast conservation surgery in early breast cancer patients at a tertiary care centre in Marathwada region of Maharashtra, India. Materials and Methods: This prospective interventional study included 40 patients in the age group of 20-65 years with stage I or stage II breast cancer was carried out in Government Medical College and Hospital, Aurangabad, India. Once staging workup was done, all patients were evaluated for suitability of BCS. Surgical treatment consisted of wide local excision and axillary dissection with gross tumour surgical margin of 2 cm. Surgical morbidity like prolonged seroma formation, surgical site infection, haematoma, lymphoedema was assessed postoperatively. Pathological assessment included primary tumour size, histological type, margin status. Radiotherapy was given to all patients. Chemotherapy was used where indicated with the appropriate regimen. All patients were followed up at three months, six months and 12 months. Cosmetic outcome was assessed by Harris four point Likert Scale. Descriptive statistics was used and results were expressed in terms of frequency and percentages. Results: In this study; 28 (70%) patients had no postoperative wound complications. About 4 (10%) had surgical site infection, and 8 (20%) had prolonged seroma formation. Out of 40 patients, 37 (92.5%) patients postoperatively had all the margins free from the disease on histopathology, 2 (5%) had single margin positive which required revision surgery, and 1 (2.5%) had all the margins positive; hence Modified Radical Mastectomy (MRM) was performed. The cosmetic outcome was good to excellent in 34 (85%) cases. Conclusion: Breast conserving surgery had a good cosmetic outcome. Most patients had disease free margins.

Letter: Sacroplasty Augmentation of Instrumented Pelvic Reconstruction After High Sacrectomy: A Technical Case Report.

Letter: Sacroplasty Augmentation of Instrumented Pelvic Reconstruction After High Sacrectomy: A Technical Case Report.

Incidental Gastrointestinal Stromal Tumors (GIST) During Laparoscopic Sleeve Gastrectomy Procedures: a Retrospective Study.

Gastrointestinal stromal tumors (GIST) are the most frequently occurring form of mesenchymal tumors in the gastrointestinal tract. Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric operation in which a portion of the gastric body and fundus is removed and sent for pathological examination. Increasingly, bariatric surgeons have incidentally identified neoplasms in the excised portion of the stomach. The aim of this study is to explore the incidence of GIST in obese patients undergoing LSG. This is a single-center, single-surgeon retrospective case series which included 305 obese patients who underwent LSG. All excised stomach specimens were sent for pathologic analysis.. In the case of pathologically verified GIST (n = 6; 1.97%), detailed analysis was performed. In 305 LSG procedures, six cases of GIST (1.97%) were identified. The tumors were measured between 1 and 7mm and were all low grade with negative resection margins. The mean BMI was 46.38 ± 3.94kg/m2 (range: 41.61-51.77). The mean age at time of surgery was 55.33 ± 12.9years (range: 37-73years). All cases were asymptomatic and showed no evidence of metastatic disease. The incidental rate of GIST in the excised portion of the stomach in our 305 obese patients who underwent LSG is 6/305 (1.97%). This adds relevant data to the overall goal of determining whether obesity is a risk factor for GIST. Radical surgical resection of these tumors with adequate disease-free margins performed on a low-grade malignancy serves as a definitive oncological treatment, especially when there is an intact pseudocapsule.

Challenges and Opportunities for Treating Intrahepatic Cholangiocarcinoma.

Intrahepatic cholangiocarcinoma (ICC) is one of the rarest and most aggressive types of cancer. The symptoms of ICC patients can be vague, leading to late diagnosis and dismal prognosis. In this review, we investigated the treatment options for ICC, as well as ways to overcome challenges in identifying and treating this disease. Imaging remains the gold standard to diagnose ICC. Patients are staged based on the tumor, nodes and metastases (TNM) staging system. Patients eligible for surgical resection should undergo surgery with curative intent with the goal of microscopically disease-free margins (R0 resection) along with lymphadenectomy. Minimal invasive surgery (MIS) and liver transplantation have recently been offered as possible ways to improve disease outcomes. ICC recurrence is relatively common and, thus, most patients will need to be treated with systemic therapy. Several clinical trials have recently investigated the use of neoadjuvant (NT) and adjuvant therapies for ICC. NT may offer an opportunity to downsize larger tumors and provide patients, initially ineligible for surgery, with an opportunity for resection. NT may also treat occult micro-metastatic disease, as well as define tumor biology prior to surgical resection, thereby decreasing the risk for early postoperative recurrence. Adjuvant systemic therapy may improve outcomes of patients with ICC following surgery. Ongoing clinical trials are investigating new targeted therapies that hold the hope of improving long-term outcomes of patients with ICC.

Unicentric Castleman disease; the laparoscopic en bloc resection of a hypervascular giant lymph node in the aortacaval zone

Unicentric Castleman disease (UCD) is a rare disease of the lymph nodes with unknown etiology, most commonly presenting as localized asymptomatic adenopathy incidentally discovered on radiographic imaging. The retroperitoneum is a rare site for UCD, where it can mimic malignant tumors. Complete surgical resection with disease-free margins is considered both diagnostic and curative. However, this may be challenging due to the high vascularity and close proximity of UCD to major vessels. A 42-year-old patient with a 46x44x26 mm mass in the aortocaval area at the level of the renal pelvis underwent surgery with the suspicion of metastatic lymphadenopathy. Laparoscopic excision of the mass was carried out and the histopathological examination revealed the presence of UCD. This video article aimed to demonstrate the surgical steps and techniques used to minimize hemorrhage during dissection of UCD. Laparoscopy is safe and effective in the diagnosis and treatment of UCD, provided the operating surgeons have a thorough knowledge of abdominal anatomy and are aware of the functions and limitations of surgical devices used during laparoscopy.

Long noncoding RNA CCAT1 rs67085638 SNP contribution to the progression of gastric cancer in a Polish population

The role of the long noncoding RNA CCAT1 NC_000008.10:g.128220661C > T (rs67085638) in the development of colon cancer has been reported. Therefore, we assessed the prevalence of rs67085638 in patients with gastric cancer (GC). We also evaluated the effect of rs67085638 on B-cell-specific Moloney leukaemia virus insertion site 1 (BMI1) transcripts in primary GC and counterpart histopathologically confirmed disease-free margin tissue. Using high-resolution melting analysis, we evaluated rs67085638 frequency in patients with the GC genotype (n = 214) and controls (n = 502) in a Polish Caucasian population. qRT-PCR was used to determine BMI1 transcripts. We observed the trend of rs67085638 association in all patients with GC (ptrend = 0.028), a strong risk of the GC genotype in male (ptrend = 0.035) but not female (ptrend = 0.747) patients, and the association with non-cardia GC (ptrend = 0.041), tumour stages T3 (ptrend = 0.014) and T4 (ptrend = 0.032), differentiation grading G3 (ptrend = 0.009), lymph node metastasis stage N3 (ptrend = 0.0005) and metastasis stage M0 (ptrend = 0.027). We found that significantly increased BMI1 transcripts were associated with the primary GC genotype classified as grade G3 (p = 0.011) and as lymph node metastasis N3 (p = 0.010) and counterpart marginal tissues (p = 0.026, p = 0.040, respectively) from carriers of the T/T versus C/C genotypes. rs67085638 may contribute to increased BMI1 transcripts and the progression and rapid growth of GC.

Rectal Shaving for Bowel Endometriosis by Laparoscopic Reverse Submucosal Dissection for Easier, Safer and More Complete Excision of Disease

To demonstratefull-thickness excision of the affected muscularis along the submucosal plane. Stepwise demonstration of LRSD technique with narrated video footage. LRSD takes advantage of the submucosal layer of the bowel wall and uses it as an easier line of excision for rectal endometriosis compared with the very difficult traditional line of excision of irregular disease-muscularis interface. The expansion of the submucosal layer by the injection separates the affected muscularis away from the mucosa, making it safer to excise the lesion with less chance of entering the bowel lumen. Excision of disease is more complete with LRSD because the full-thickness excision of the muscularis layer includes the healthy deep muscularis, which will form the disease-free deep excision margin. This video will highlight anatomic and technical aspects of LRSD including the following key steps: 1. Mobilization of diseased bowel segment 2. Submucosal injection 3. Circumferential incision of the muscularis 4. Submucosal dissection along the submucosal plane 5. Bowel wall integrity test 6. Muscularis defect repair CONCLUSION: Rectal shaving by LRSD appears to be easier, safer, and more complete in excision of bowel endometriosis than the classical rectal shaving technique. This modification requires further evaluation to confirm its potential in the surgical management of rectosigmoid deep infiltrative endometriosis.

486 Are Surgical Resection Margins A Risk Factor for Crohn’s Disease Recurrence?

Abstract Despite advances in treatment, Crohn’s disease (CD) recurrence is still high. Various factors correlated with recurrence are studied however, there is no consensus regarding the importance of disease-free resection margins. Our goal was to ascertain whether surgical margins predict recurrence rates of CD and identify other potential factors correlated with recurrence. This is a retrospective cohort study on patients who have had a colonic resection for CD from December 2016 to November 2019. Demographics, surgical procedure details, disease activity at resection margins and number of readmissions were recorded. Clinical recurrence was defined as readmission to hospital for a Crohn’s related flare-up within 12 months of surgical resection. Positive disease activity at the resection margins was defined histologically. We compared the readmission rate between all categories. Of the 55 patients identified, 52 (22 female) were included. Of these, seven were readmitted, six are smokers, 19 had mesenteric excision and 33 had Crohn’s positive resection margins. Chi-squared tests showed there are no significant correlations between patient and procedure variables, and readmission rates (p &amp;gt; 0.05). We have not found sufficient evidence to conclude that a disease-free resection margin post colonic resection or any other patient-related factors are associated with decreased recurrence of CD.

Criteria for Excision of Suspicious Calcifications Using the Breast Lesion Excision System (BLES)

Background: The aim of the study was to retrospectively evaluate possible imaging and histopathology criteria that can be used in a clinical basis to assess the success of excision of suspicious calcifications using the breast lesion excision system (BLES).Methods: We investigated 400 BLES stereotactic biopsies of suspicious calcifications with the mean size of 15.38 mm (st. dev.= 13.579 mm, range 3-78 mm) using a 20 mm probe performed in our department between January 2014 and 2016. The mean age of our population was 58.5 years old (range 39-78 years). The pathology results of BLES specimens were compared with the final surgical results to assess excision success rates. Possible imaging and histopathology criteria for removal were statistically analyzed (mammographic size, disease free margins, grade, comedo phenotype, molecular type).Results: The results showed that 90/400 (22.5%) biopsies were cancers (80% DCIS) and 38/400 were lesions with cell atypia (9.5%) of which 29/38 had subsequent surgery and were included in the study. Excision was achieved in 31/90 cancers (34.4%) and in 23/29 lesions with cell atypia (76.3%). The imaging and histopathology criteria for BLES excision that could be potentially clinically assessed were the initial mammographic size (p&lt;0.001), the distance of the lesion from the specimen margins (p&lt;0.001), the presence of comedo necrosis (p=0.014) and the grade of the cancers (p=0.021). The underestimation rate was 15.5%. Conclusion: the mammographic size, grade, comedo presence and disease-free margins, were the main criteria for BLES success rate of excision of suspicious calcifications.

Robotic Versus Open Liver Resection in Hepatocarcinoma: Surgical and Oncological Outcomes.

Minimally invasive approaches are spreading in every field of surgery, including liver surgery. However, studies comparing robotic hepatectomy with the conventional open approach regarding oncologic outcomes for hepatocellular carcinoma are limited. We retrospectively reviewed demographics characteristics, pathologic features, surgical, and oncological outcomes of patients who underwent robotic and conventional open liver resection for hepatocellular carcinoma. No significant differences in demographics features, tumor size, tumor location, and type of liver resection were found. The morbidity rate was similar, 23% for the open group versus 17% of the robotic group (P=0.605). Perioperative data analysis showed a greater estimated blood loss in patients who underwent open resection, if compared with robotic group (P=0.003). R0 resection and disease-free resection margins showed no statistically significant differences. The 3-year disease-free survival of the robotic group was comparable with that of the open group (54% vs. 37%; P=0.592), as was the 3-year overall survival (87% vs. 78%; P=0.203). The surgical and the oncological outcomes seem to be comparable between minimally invasive and open hepatectomy. Robotic liver resections are effective, and do not compromise the oncological outcome, representing a reasonable alternative to the open approach.