Incomplete Excision Research Articles

Comparative Analysis of Percutaneous Excision and Radiofrequency Ablation for Osteoid Osteoma.

BACKGROUND This retrospective study aims to compare the efficacy of computed tomography-guided percutaneous excision and radiofrequency ablation in the treatment of osteoid osteoma. MATERIAL AND METHODS We evaluated 40 patients with osteoid osteoma who underwent either percutaneous excision or radiofrequency ablation between 2012 and 2015. The cohort consisted of 10 female and 30 male patients, with a mean age of 15.1 years (range: 4-27 years) and a mean follow-up time of 19.02 months (range: 11-39 months). Percutaneous excision was performed in 20 patients, while radiofrequency ablation was performed in the remaining 20 patients. RESULTS The success rates of percutaneous excision and radiofrequency ablation were comparable, with unsuccessful outcomes observed in 10% and 5% of patients, respectively. The reasons for failure in the percutaneous excision group were attributed to a marking error and incomplete excision of the wide-based nidus. Complications were limited to pathological fracture (n=1) and deep infection (n=1) in the percutaneous excision group, while no complications were encountered in the radiofrequency ablation group. CONCLUSIONS Both percutaneous excision and radiofrequency ablation demonstrate high success rates in treating osteoid osteoma. However, radiofrequency ablation offers the advantage of a quicker return to daily activities without the need for activity restrictions or splints. While being a more cost-effective option, percutaneous excision should be considered cautiously to minimize potential complications.

Accuracy of Time to Treatment Initiation Data in Musculoskeletal Soft Tissue Sarcoma.

Time to treatment initiation (TTI) is a quality metric in cancer care. The purpose of this study is to determine the accuracy of TTI data from a single cancer center registry that reports to the National Cancer Database (NCDB) for sarcoma diagnoses. A retrospective analysis of a single Commission on Cancer (CoC)-accredited cancer center's tumor registry between 2006 and 2016 identified 402 patients who underwent treatment of a musculoskeletal soft tissue sarcoma and had TTI data available. Registry-reported TTI was extracted from the tumor registry. Effective TTI was manually calculated by medical record review as the number of days from the date of tissue diagnosis to initiation of first effective treatment. Effective treatment was defined as oncologic surgical excision or initiation of radiation therapy or chemotherapy. Registry-reported TTI and effective TTI values were compared for concordance in all patients. In the entire cohort, 25% (99/402) of patients had TTI data discordance, all related to surgical treatment definition. For patients with a registry-reported value of TTI = 0 days, 74% (87/118) had a diagnostic surgical procedure coded as their first treatment event, with 73 unplanned incomplete excision procedures and 14 incisional biopsies. In these patients, effective TTI was on average 59 days (P < 0.001). For patients with a registry-reported value of TTI >0 days, only 4% (12/284) had discordant TTI values. Nearly three-fourths of patients with a registry-reported value of TTI = 0 days in a large, CoC-accredited cancer center registry had a diagnostic procedure coded as their first treatment event, though their effective treatment had not yet started. These data suggest that TTI is likely longer than what is reported to the NCDB. Redefinition of what constitutes surgical treatment should be considered to improve the accuracy of data used in measuring TTI in sarcoma.

O056 The impact of surgical risk factors on the development of stump appendicitis

Abstract Introduction Stump appendicitis (SA) is a post-operative complication where inflammation occurs in the residual appendix following incomplete excision. Diagnosis is delayed due to the history of appendectomy, leading to a higher risk of complications such as perforation and peritonitis. This study aimed to investigate the incidence of SA and the surgical risk factors contributing to its development. Methods A literature review was conducted using Ovid Medline and Embase to evaluate the literature surrounding SA. A retrospective study was conducted at our centre to investigate the incidence of SA between June 2012 and June 2022. Results Literature review revealed 43/12,989 (0.33%) patients with SA. In the local cohort of 5401 patients who underwent appendectomy or right hemicolectomy for appendicitis, 15 developed SA (0.28%). Laparoscopic appendectomy was identified as a risk factor, with 66.67% of SA patients in Cardiff undergoing laparoscopic surgery for their primary appendicitis. Complicated primary appendicitis was reported in 53.33% of SA patients compared to 19.33% of the wider cohort. An appendicolith was present in 33.33% of SA patients compared to 12.11% of the total cohort. Residual stump length above 1.5cm was also acknowledged as a risk factor with a stump length ≥1.5cm reported in all local SA patients. Conclusion SA is associated with modifiable and non-modifiable risk factors. Care should be taken to identify the appendiceal base clearly at primary operation. Complicated appendicitis and the limitations of laparoscopic appendectomy present challenges in identifying the appendiceal base, thus contributing to the development of SA.

A thalamic epidermoid cyst presenting with memory disturbances: a case report.

We present a 20-year-old college student who presented with memory disturbances. The imaging revealed a left thalamic mass. The tumor was excised and diagnosed histopathologically as an epidermoid cyst. Epidermoid cysts resemble epidermal skin cells in histology. The lesion of the thalamus involving the ventrolateral and anterior regions is involved with memory and language. Of note, to our knowledge, no cases of memory issues associated with thalamic epidermoid cysts have been reported in the literature. The ideal treatment is cystic component removal with complete capsule excision. Sometimes, in cases of incomplete excision, radiotherapy can be another option.

Rare recurrence of a multilocular cystic leiomyoma following myomectomy.

Multilocular cystic leiomyomas rarely develop following myomectomy. To the best of our knowledge, there are no published reports on recurrent multilocular cystic leiomyoma following myomectomy. We here present such a case. A 45-year-old woman visited our outpatient clinic because of heavy vaginal bleeding. She underwent laparoscopic myomectomy for a solid mass in the uterine cavity. Subsequent pathological examination of the operative specimen revealed a tumour with well-demarcated borders and spindle cells arranged in intersecting fascicles. Seven days postoperatively, ultrasonography revealed a cystic lesion. Magnetic resonance imaging performed 28 months postoperatively revealed a large, well-defined, multilocular cystic mass that was homogeneously hyperintense on T2-weighted images on the exterior of the uterus. Abdominal hysterectomy was performed. On pathological examination of the operative specimen, she was found to have a leiomyoma with marked cystic degeneration. Incomplete excision of a multilocular cystic leiomyoma may result in recurrence in the form of a large cystic mass. Clinical differentiation between a multilocular cystic leiomyoma and an ovarian tumour may be difficult. Complete resection of a uterine multilocular cystic lesion prevents recurrence.

Carcinoma basocelular en el Área Sur de Salud de Tenerife. Características clínico-patológicas fundamentales y estado de los bordes tras exéresis

Background and objectiveSurgical excision is the treatment of choice for basal cell carcinoma (BCC). Complete excision with clear margins is important for reducing the risk of recurrence. The aims of this study were to describe the characteristics of BCCs in our health care area, calculate the percentage of positive margins after surgical excision, and determine the risk factors for incomplete excision. Material and methodsRetrospective observational study of BCCs that were surgically removed at Hospital Universitario Nuestra Señora de Candelaria, in Santa Cruz de Tenerife, Spain, between January 1, 2014 and December 31, 2014. Information was collected on demographic, clinical, and histologic variables, surgical approach, margin status, and the department responsible. ResultsIn total, 966 BCCs were diagnosed in 776 patients. Nine percent of tumors with complete data were biopsied, 89% were surgically excised, and 2% were removed by shave excision. The median age of patients with excised tumors was 71 years and 52% were men. BCCs were most often located on the face (59.1%). Surgical margins were analyzed in 506 cases, 17% of which had positive margins. Incomplete excision was significantly more common in tumors located on the face (22% vs. 10% for other locations) and in high-risk subtypes according to the World Health Organization classification (25% vs. 15% for low-risk subtypes). ConclusionsThe characteristics of BCCs in our health care area are similar to those described elsewhere. Facial location and histologic subtype are risk factors for incomplete excision. Careful surgical planning is therefore important in the initial management of BCCs with these characteristics.

Giant cell tumor of tendon sheath in the pediatric population – review

Giant cell tumor of tendon sheath is a rare and benign soft-tissue tumor, which is even less common in the pediatric population. It may be connected with chromosomal translocations, often the 1p11-13. Symptoms include pain, swelling, palpable mass or limited range of motion. Magnetic resonance is the diagnostic method of choice. Histopathological image obtained from biopsy should be also evaluated. The gold standard of treatment is total surgical resection of the tumor, as incomplete excision may result in recurrence. Physicians should also consider the future function of the affected joint or limb. Our aim was to review the available literature about GCTTS in the pediatric population.

The Combined Robotic-assisted Laparoscopic and Thoracic Approach in the Management of Diaphragmatic, Pleural, and Pericardial Endometriosis

To demonstrate the advantages of a combined robotic-assisted laparoscopic and thoracic approach in the management of extensive diaphragmatic, pleural, and pericardial endometriosis. A video article demonstrating excision of endometriosis from pericardium, diaphragm, and pleura. Thoracic endometriosis is the most common site of extrapelvic endometriosis [1]. Surgical treatment aims to excise all visible disease to relief symptoms and prevent recurrence [2-4]. A 41-year-old lady with cyclical shoulder tip and chest pain and known extensive diaphragmatic endometriosis was referred to our center. The procedure was done jointly by a gynecologist and a thoracic surgeon experienced in robotic-assisted endometriosis excision (Supplemental Video 1). Robotic-assisted laparoscopy revealed extensive full-thickness diaphragmatic endometriosis and a full-thickness pericardial nodule. Pericardial endometriosis excision was performed and a 1 cm defect was left open in the pericardium. Multiple diaphragmatic endometriotic nodules were excised and pleural cavity was entered (Image 2). On robotic-assisted thoracic surgery, further deep endometriotic lesions were detected and excised from the posterior aspect of the diaphragm. These lesions were not identified abdominally despite complete division of falciform ligament, full mobilization of the liver, and the use of a 30-degree scope. Superficial endometriotic lesions on parietal pleura were also detected (Image 3) and excised. The defects on the diaphragm were closed (Image 4). Chest and abdominal drains were left in situ. The patient was discharged on day 4. The combined robotic-assisted laparoscopic and thoracic approach is indicated in selected cases and allows full exploration of the thoracic cavity and both sides of the diaphragm, thus preventing incomplete excision of the disease. Robotic surgery also allows smooth dual-surgeon teamwork.

Symphyseal-Sparing Mandibulectomy for Canine Acanthomatous Ameloblastoma in Dogs: 35 Cases.

Canine acanthomatous ameloblastoma (CAA) has been reported to be the most prevalent odontogenic tumor in dogs. The most common location of this tumor is the rostral mandible. Symphyseal-sparing mandibulectomy has been shown to be an effective technique to maintain mandibular continuity and promote early return to function. In this retrospective study, 35 dogs with CAA associated with a mandibular canine tooth were evaluated following a symphyseal-sparing rostral mandibulectomy. Dogs with intraoperative transection of the canine tooth root and subsequent root fragment extraction were included. The objective of this study was to evaluate outcome following excision of CAA with mid-root transection. Data retrospectively evaluated in this study included the following: narrowest tumor margin, narrowest tumor margin at the border associated with the transected canine root, tumor size, and prevalence of local recurrence. This study showed that 82.86% of CAA were completely excised with tumor-free margins (N = 29). The median narrowest overall tumor-free margin was 3.5 mm (interquartile range [IQR] 2.0-6.5 mm) and the median tumor-free margin associated with the border of the transected canine root was 5.0 mm (IQR 3.1-7.0 mm). Follow-up data was obtained in 25 cases via phone interviews with referring veterinarians and clients. No local tumor recurrence was reported in cases with incomplete tumor excision (N = 5). All dogs with follow-up data survived at least 1 year following surgery. It was concluded that segmental or rostral mandibulectomy with wide margins to include the entire mandibular canine tooth with subsequent mandibular instability may not be warranted for dogs with CAA associated with this tooth.

Absence of gut microbiota impairs depletion of Paneth cells but not goblet cells in germ-free Atoh1lox/lox VilCreERT2 mice.

Mouse atonal homolog 1 (Math1/Atoh1) is a basic helix-loop-helix transcription factor important for the differentiation of secretory cells within the intestinal epithelium. The analysis of Paneth depletion efficiency on Math1lox/loxVilCreERT2 (Math1ΔIEC) mice treatment with tamoxifen in the presence or absence of intestinal microbiota showed a failure on Paneth cell depletion in germ-free mice as compared with specific pathogen-free (SPF) mice. However, goblet cells were efficiently depleted in Math1ΔIEC germ-free mice. The gene expression of Math1 was significantly reduced in the ileum of germ-free Math1ΔIEC mice 5 days after tamoxifen injection as compared with germ-free control, but its protein expression was still detectable in the nuclei of epithelial cells in the crypts. Germ-free mice showed low proliferative ileal crypts and apoptotic cells that were mainly detected in the tip of the villus, consistent with a slow turnover rate of epithelial cells. Although Paneth cells were not depleted in germ-free Math1ΔIEC mice for the first 7 wk after the last tamoxifen injection, far already from the 5 days time-laps observed in SPF conditions, an incomplete depletion of Paneth cells was observed 14 wk after the last tamoxifen injection. Colonization of germ-free mice restored the phenotype observed in SPF mice, highlighting the regulatory role of gut microbes in our model. We conclude that absence of intestinal microbiota in Math1ΔIEC mice is associated with reduced epithelial cell renewal and delays the depletion of preexisting Paneth cells.NEW & NOTEWORTHY Cre-lox system is a powerful and widely used research tool developed to understand the specific role of genes. It allows to control the spatial and temporal expression of genes in experimental models. Several limitations including toxicity of Cre recombinase or incomplete excision of floxed loci have been reported in the past. To date, this is the first research study reporting that gut microbes also influence the expected phenotype of Paneth cell depletion in the genetically modified Math1lox/loxVilCreERT2 mouse model.

Validating a novel natural language processing pathway for automated quality assurance in surgical oncology: incomplete excision rates of 34 955 basal cell carcinomas.

Validating a novel natural language processing pathway for automated quality assurance in surgical oncology: incomplete excision rates of 34 955 basal cell carcinomas.

Optical coherence tomography for presurgical delineation of basal cell carcinomas on the face-A comparison with histopathology.

To minimize the risk of incomplete excision of basal cell carcinomas (BCC) the macroscopic tumor margins should be adequately defined. Optical coherence tomography (OCT) is a non-invasive imaging tool that can provide structural and vascular information about skin cancer lesions. The study objective was to compare the presurgical delineation of facial BCC by clinical examination, histopathology, and OCT imaging in tumors undergoing full excision. Ten patients with BCC lesions on the face were examined clinically, with OCT and histopathology at 3-mm intervals, from the clinical lesion border and beyond the resection line. The OCT scans were evaluated blinded and a delineation estimate of each BCC lesion was made. The results were compared to the clinical and histopathologic results. OCT evaluations and histopathology were in agreement in 86.6% of the collected data points. In three cases the OCT scans estimated a reduction of the tumor size compared to the clinical tumor border set by the surgeon. The results of this study support the notion that OCT can have a role in the clinical daily practice by aiding clinicians in delineating BCC lesions before surgery.

Invasive Lobular Carcinoma: A Review of Imaging Modalities with Special Focus on Pathology Concordance.

Invasive lobular cancer (ILC) is the second most common type of breast cancer. It is characterized by a unique growth pattern making it difficult to detect on conventional breast imaging. ILC can be multicentric, multifocal, and bilateral, with a high likelihood of incomplete excision after breast-conserving surgery. We reviewed the conventional as well as newly emerging imaging modalities for detecting and determining the extent of ILC- and compared the main advantages of MRI vs. contrast-enhanced mammogram (CEM). Our review of the literature finds that MRI and CEM clearly surpass conventional breast imaging in terms of sensitivity, specificity, ipsilateral and contralateral cancer detection, concordance, and estimation of tumor size for ILC. Both MRI and CEM have each been shown to enhance surgical outcomes in patients with newly diagnosed ILC that had one of these imaging modalities added to their preoperative workup.

A Sampling of Highlights from the Literature

What We're Reading| March 01 2023 A Sampling of Highlights from the Literature: Article Recommendations from Our Deputy and Senior Editors Author & Article Information Online ISSN: 2326-6074 Print ISSN: 2326-6066 ©2023 American Association for Cancer Research2023American Association for Cancer Research Cancer Immunol Res (2023) 11 (3): 277. https://doi.org/10.1158/2326-6066.CIR-11-3-WWR Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Article Versions Icon Versions Version of Record March 1 2023 Citation A Sampling of Highlights from the Literature: Article Recommendations from Our Deputy and Senior Editors. Cancer Immunol Res 1 March 2023; 11 (3): 277. https://doi.org/10.1158/2326-6066.CIR-11-3-WWR Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest Search Advanced Search Human fibrinogen E domain (from 5-HT2AR via Wikimedia Commons) Incomplete surgical removal of a solid tumor increases a patient's risk for local tumor recurrence. Using xenograft models of incomplete excision of pancreatic ductal adenocarcinoma (PDAC) and triple-negative breast cancer (TNBC), Uslu and colleagues show that intra-operative application of mesothelin-targeted chimeric antigen receptor (CAR) T cells in a fibrin glue–based carrier results in clearance of residual tumor cells and increased survival compared with the same application of the CAR T cells into the tumor cavity in the absence of fibrin gel. The treatment had limited on-target off-tumor toxicity and did not lead to wound healing complications, supporting its clinical evaluation. Uslu U, …, June CH. Sci Adv 2023 January 11;9:eade2526. Neutrophil (from Blausen Medical via Wikimedia Commons) Neutrophils have a complex role in cancer. They often promote tumor growth and metastasis but can exert antitumor activity in certain contexts. Using... You do not currently have access to this content.

Quadruple Assessment using Transrectal Ultrasound Scan is Effective at Accurately Facilitating Choice of Excision Plane by Tems in the Complex Specc Lesion

Background: There is currently no consensus as to the optimal imaging modality for Significant Polyps and Early Colorectal Cancer (SPECC). This study describes the use of transrectal ultrasound (TRUSS) as part of a quadruple assessment process to evaluate the depth of invasion of SPECC lesions and guide local excision. Method: Pre-operative imaging and histology were reviewed for all patients undergoing transanal endoscopy microsurgery (TEMS) at Cheltenham General Hospital between 2013 and 2019. Treatment options included mucosectomy, partial thickness excision and full thickness excision. The dataset was studied specifically to evaluate the risk that malignancy will be present at the deep margin. ‘Failure’ of assessment was thus defined as the failure to detect and achieve complete local excision of malignancy. Results: 400 patients were included: 319 primary lesions and 81 secondary lesions. Amongst the primary lesions 93.7% (n=299) had successful R0 excisions. Of the primary lesions with incomplete excisions 50% (N=10) had undergone mucosectomy, 40% (n=8) full thickness excision and 10% (n=2) partial thickness excision

Audit of 100 consecutive basal cell carcinoma specimens at a secondary care centre in the UK.

To audit basal cell carcinoma resections against standard guidelines. The retrospective study was done at the Department of Pathology, Sherwood Forest Hospital, Nottinghamshire, United Kingdom, from July 2020 to December 2020 and comprised basal cell carcinoma cases regardless of age and gender. All parameters laid down by the Royal College of Pathologists were matched with the data. Also, incompletely resected specimens were separated, and reasons for incomplete resection were taken into account, and compared with the British Association of Dermatologists 2018 guidelines. Of the 100 consecutive cases, 67(67%) were nodular and nodulocystic, 8(8%) were superficial multifocal, 7(7%) each were infiltrative and mixed nodular and infiltrative, 6(6%) were mixed nodular and superficial, and 5(5%) were mixed superficial and infiltrative. All 100(100%) pathology reports contained the mandatory information set by the Royal College of Pathologists. There were 7(7%) incompletely excised cases. The rate of incomplete excision was also within the acceptable range defined by the British Association of Dermatologists 2018 guidelines. All basal cell carcinoma resections were in line with the standard guidelines.

Real-Life Data on the Management of Incompletely Excised Basal Cell Carcinoma

Background: The histopathologic presence of basal cell carcinoma (BCC) cells at one or more margins of the specimen after surgical excision is considered suggestive of incomplete tumor clearance. The management of incompletely excised BCC might vary in different clinical scenarios from re-excision to application of other treatments or even watchful waiting. Objective: The aims of the study were to report the real-life management of incompletely excised BCC in a tertiary referral center and compare the recurrence rates according to the selected management modality. Methods: A retrospective study was conducted at a tertiary Dermatology Center in Northern Greece. Our electronic database was scanned over a 5-year period to retrieve all BCCs with available histopathologic assay reporting at least one involved margin (lateral or deep). The included patients were divided into 3 groups according to the selected management after incomplete excision: group 1 included those who underwent immediate re-excision (n = 26), group 2 those who were followed up without any additional therapy (n = 40), and group 3 those who were treated with adjuvant/complementary non-surgical treatment (n = 18). Finally, we recorded the presence or absence of residual tumor in the new histopathologic report of those tumors that were selected to be re-excised (group 1). The primary outcome was the appearance of clinical tumor recurrence. Results: Of 1,689 BCCs recorded in our database, 84 met the inclusion criteria and were included in the analysis. Re-excision had been selected in 26 of 84 patients (group 1), watchful waiting in 40 (group 2), and non-surgical treatments in 18 (group 3). The histopathologic reports of the 26 tumors of group 1 that were re-excised revealed residual tumor in 14 (53.8%) cases. Overall, a clinical recurrence occurred in 14 of 84 patients (16.7%) after a mean follow-up of 17 months. The median time to recurrence was 14 months. Of 40 patients without any treatment, recurrence developed in 10 (25%), while only 2 of 18 patients treated with non-surgical treatments recurred (11.1%). Conclusions: Our study suggests that positive histopathologic margins after BCC excision result in a clinical recurrence only in a proportion of patients. This percentage is higher when no further treatment is applied and lower when the area is re-excised or treated with imiquimod alone or combined with cryotherapy.

Dermatofibrosarcoma protuberans - an atypical tumor with a typical diagnostic dilemma: a case report

Dermatofibrosarcoma protuberans (DFSP) is a rare tumor of dermal fibroblast. Diagnosis poses a challenge to every surgeon. Its propensity to recur can be attributed to its characteristic finger-like projections, misdiagnosis, and incomplete excision. Wide local excision with adequate margins may lead to functional defects and cosmetic blemishes. Most cases undergoing second surgery warrants reconstructive procedure which might further complicate the management. We report a case of DFSP, initially misdiagnosed and underwent incomplete excision, later presented with recurrence and atypical features. High-grade suspicion is of paramount importance for ascertaining the diagnosis of DFSP and its appropriate treatment.

Intra-abdominal Cystic Lymphangiomas: The Vanderbilt Experience

IntroductionLymphangiomas are rare, cystic tumors that represent congenital malformation of the lymphatic vessels. We reviewed our institution's experience treating abdominal lymphangiomas with the purpose of describing the clinical features, management, and outcomes of this rare pathology. MethodsThis is a single-institution, institutional review board-approved retrospective review of abdominal lymphangiomas presenting between January 2010 and February 2021. The diagnosis of lymphangioma was made on histopathology from either endoscopic or excisional biopsy of the lesion. Demographics, diagnostic imaging, histopathologic characteristics, and outcomes were analyzed. ResultsWe identified 48 patients, of whom 29 (60%) were female, >18 y (38; 79%), with a mean age of 43 y at the time of diagnosis (range, 4 d-87 y). Tumors ranged in size from <1 cm to 30 cm. Only 1/3 were symptomatic, most commonly with abdominal pain (9; 19%) On preoperative imaging, mural nodules or thickened walls were present in one case, in which pathology was consistent with benign lymphangioma. The majority of lymphangiomas were associated with the small bowel or its mesentery (31; 65%), followed by the colon/omentum (7; 15%). Most patients underwent surgical excision (29; 60%) with incomplete excision in one patient due to extensive local invasion, and three (10%) patients required multivisceral resection. The median duration of the follow-up was 13 mo (range, 1-105 mo), during which time, none of the patients developed malignancy. ConclusionsMost abdominal lymphangiomas arise from the small bowel and are found incidentally and have a favorable prognosis. Resection should be reserved for symptomatic lesions or when there is a diagnostic uncertainty.

Management of “Large” Vascular Malformation: An Institutional Review

Background: Large vascular malformations (VM) are complex lesions anatomically, functionally or both. The criteria to define “Large” vascular malformations were unclear. This study aims to retrospectively identify Large VM based on clinical features and discussed about the method we adopted in management. Methods: This is retrospective study of analyzing all patients of vascular malformations treated by us since 2003. The criteria to categorize large vascular malformations were outlined after analyzing the anatomical area of involvement, functional disturbances by these lesions, operability of the lesions, morbidity associated with resection, and the requirement of reconstruction. All cases were managed by a multi-disciplinary team. Various methods utilized to control the bleeding varied from simple wound packing to cardiopulmonary bypass (CPB) assistance. The resection was either curative or palliative. Complete excision in the form of radical resection was carried out in all possible cases intended with curative aim. Vascularized tissue transfer was done to reduce the morbidity following surgical resection. Results: Out of 268 patients, 26 patients fulfilled the criteria for large vascular malformations. The predominant site of involvement is head and neck. 80% had more than one indication for surgery. Majority of the cases 54% were arterio-venous malformations (AVM) followed by 31% of capillary venous malformations (CVM). The commonest indication for surgery is bleeding in 73% followed by cosmetic disfigurement in 61.5%. Compressive wound packing with delayed wound closure and preoperative embolization were the commonly employed methods for bleeding control. CPB assisted resection was carried out in 5 cases. On analysing the recurrence, 7.7% had in complete excision, 36% in incomplete excision and 12% in cases of vascularized tissue transfer. Conclusion: The clinical criteria outlined in our study will be useful in identifying “Large” vascular malformations. Compression wound packing with delayed closure plays a major role in bleeding control immediately after resection. CPB assistance for aiding resection can be considered in selected cases. Complete resection in the form of radical excision will reduce the recurrence. Palliative resection provides symptom free disease when complete resection is not viable. The tissue transfer for the wound cover controls the residual disease in cases of incomplete resection.