Optimal Margin Research Articles

Current standards of surgical management of gastric cancer: an appraisal.

Gastric cancer (GC) is the fifth most common malignancy worldwide and portends a grim prognosis due to a lack of appreciable improvement in 5-year survival. We aimed to analyze the available literature and summarize the current standards of surgical care for curative and palliative intent treatment of GC. We conducted a systematic search on the PubMed database for studies on the management of GC. Endoscopic resection is an acceptable treatment option for T1a tumors. The role of optimal resection margin for GC remains unclear. D2 lymph node dissection remains the standard of care with splenectomy needed selectively for splenic hilum involvement. A distal pancreatic resection should be avoided. The advantage of bursectomy and omentectomy in GC surgery is not clear. Multi-visceral resection may be considered for locally advanced GC in carefully selected patients. Minimally invasive approaches are non-inferior to open surgery. Surgery should be abandoned prior even in metastatic GC within the frame of multimodal therapy approach. Various trials have conclusively shown improved patient outcomes when well-established surgical standards are followed.

Optimal bowel resection margin in colon cancer surgery: prospective multicentre cohort study with lymph node and feeding artery mapping

There are no standardised criteria for the 'regional' pericolic node in colon cancer, which represents a major cause of the international uncertainty regarding the optimal bowel resection margin. This study aimed to determine 'regional' pericolic nodes based on prospective lymph node (LN) mapping. According to preplanned invivo measurements of the bowel, the anatomical distributions of the feeding artery and LNs were determined in 2996 stages I-III colon cancer patients who underwent colectomy with resection margin >10cm at 25 institutions in Japan. The mean number of retrieved pericolic nodes was 20.9 (standard deviation, 10.8) per patient. In all patients except seven (0.2%), the primary feeding artery was distributed within 10cm of the primary tumour. The metastatic pericolic node most distant from the primary tumour was within 3cm in 837 patients, 3-5cm in 130 patients, 5-7cm in 39 patients and 7-10cm in 34 patients. Only four patients (0.1%) had pericolic lymphatic spread beyond 10cm; all of whom had T3/4 tumours accompanying extensive mesenteric lymphatic spread. The location of metastatic pericolic node did not differ by the feeding artery's distribution. Postoperatively, none of the 2996 patients developed recurrence in the remaining pericolic nodes. The pericolic nodes designated as 'regional' were those located within 10cm of the primary tumours, which should be fully considered when determining the bowel resection margin, even in the era of complete mesocolic excision. Japanese Society for Cancer of the Colon and Rectum.

Recurrence is Not Associated with Margin Status in Phyllodes Tumor.

Phyllodes tumor (PT) is a rare fibroepithelial neoplasm of the breast. The proper extent of resection is still under debate. This study aimed to investigate the optimal surgical margin to prevent recurrence after surgery for PT and to evaluate risk factors for local recurrence (LR). Retrospective analysis of a prospective cohort database was performed. Patients who underwent curative surgery for PT at Seoul National University Bundang Hospital between July 2003 and February 2022 were reviewed. Of the 439 patients included, 285 were benign, 129 were borderline, and 25 were malignant. There was no statistically significant difference in 5-year disease-free survival (DFS) between margin-negative and margin-involved patients (87.3% vs. 85.1%, p = 0.081). When patients were classified into groups, according to margin status, as conventional (≥ 1cm from tumor), close (< 1cm from tumor), or involved, 5-year DFS rates were also similar (100% vs. 86.9% vs. 85.1%, p = 0.170). In subgroup analysis for different histologic grades, 5-year DFS was not affected by margin involvement. In univariate analysis, large tumor size (> 5cm; hazard ratio [HR] 2.857, p = 0.028) and infiltrative tumor border (HR 3.096, p = 0.012) were independent risk factors for LR. Further multivariate analysis found both factors to be prognostic. Recurrence was not significantly influenced by margin status in all histological grades. In benign and borderline tumors, local excision without wide surgical margins could be sufficient, and watchful waiting could be an option for patients with positive margins after initial surgery.

Design of red chili commodity pricing using the BPMN approach and Sugeno's fuzzy inference system

Red chili is Indonesia's leading commodity. Red chili is a raw material for various food products, cosmetics, pharmaceuticals and others. Fluctuations in the availability of red chili commodity supply affect the price of red chili commodity products. Pricing can occur because of supply and demand. Un­cer­tain conditions also influence pricing due to fluctuations in raw material prices, ultimately affecting the price of carrageenan products. This condition makes price determination very difficult. Therefore, this study aims to analyze and design a pricing mechanism and determine the optimal margin in the red chili commodity marketing system. This study uses a systems analysis and design approach. Input-process-output (IPO) diagrams describe system requirements. Industrial business processes are described by the Business Process Model and Notation (BPMN) ver. 16.0. Meanwhile, to determine the optimal margin, Sugeno's fuzzy inference system approach is used by simulating the model in 3 margin scenarios: pessimistic, moderate, and optimistic. The simulation results were tested using the MAPE test, in which the results were compared between fuzzy price results and markup prices using markup values of 20%, 25%, and 30%. The analysis results show that the price is determined by demand and supply. The price obtained from the formulation of the Sugeno fuzzy model shows an optimal margin of Rp. 16,600.

A kernel-free Laplacian quadratic surface optimal margin distribution machine with application to credit risk assessment

This paper proposes a novel binary classification approach named Laplacian quadratic surface optimal margin distribution machine (LapQSODM), for semisupervised learning. This new model exploits the geometric information embedded in unlabeled samples through a manifold regularizer to overcome the problem of insufficient labeled samples. Different from the traditional support vector machines (SVMs) based on the largest minimum margin idea and using the kernel technique to address the nonlinearity in the datasets, our proposed model optimizes the margin distribution and directly generates a quadratic surface to perform the classification. This new model not only improves the generalization performance but also avoids the difficulty of searching for an appropriate kernel function and tuning its parameters. For the regular-scale datasets, we extend the classical conjugate gradient algorithm for the proposed method and design an easy iterative method to calculate its exact step size; for the large-scale datasets, we develop an unbiased estimation for the LapQSODM gradient by utilizing one or several samples and design a stochastic gradient descent with variance reduction (SVRG) algorithm that is efficient and effective. Then, we conduct a comprehensive numerical experiment on both artificial and public benchmark datasets. The experimental results show LapQSODM has a better generalization performance than most of the well-known benchmark methods and is more robust due to the optimization of the margin distribution. Finally, we apply LapQSODM to three realistic credit risk assessment problems. The promising numerical results demonstrate the great potential and ability of our model in the real practice.

Haptic feedback intervention decreases the spatial margin when older adults walk through a narrow space

BackgroundThe ability to avoid obstacles efficiently and safely is important for older adults to prevent injuries from tripping and falling. It is important to find an optimal spatial margin between the body and an obstacle considering both safety and efficiency. One side of finding the optimal margin is to decrease the margin in terms of motor efficiency. In this study, we tested whether fingertip-contact intervention to obtain haptic feedback information to perceive the relationship between body and the environment could immediately improve spatial perception and collision avoidance behavior (an instantaneous effect).MethodsTwenty-seven older adults (12 males and 15 females) participated in the experiment. In the intervention of the fingertip-contact group, they lightly touched the edge of a door with both fingertips while walking. The test task before and after the intervention involved grasping a horizontal bar and passing through a narrow opening. As dependent variables, we measured the spatial margin and the collision rate.ResultsThe fingertip-contact group showed a significant decrease in the spatial margin after the intervention. On the other hand, there was no significant improvement in the collision rate after the intervention but rather a decrease only in the control group.ConclusionThe results obtained in this study indicate that touching obstacles with the fingertips had an instantaneous effect, leading to efficient movement learning, although a possible side effect of an increased collision rated was also found. The proposed intervention might promote an efficiency-based strategy due to learning the spatial relationship between the body and the environment, and it may suppress the excessive avoidance of older adults.

Margin Status and Local Recurrence in Phyllodes Tumours of the Breast: A Canadian Series.

Phyllodes tumours of the breast are rare fibroepithelial neoplasms with a propensity for recurrence. While surgical excision remains the standard of care, the optimal margin width is an area of active investigation. Recent studies have questioned the necessity for wide, local excision. We conducted a retrospective, cohort study of patients with phyllodes tumours treated at our institution between 2003 and 2021. Demographic, histopathological, and recurrence data were captured; malignant phyllodes were excluded. Cox proportional hazard models were used to identify covariates associated with local recurrence. Of 187 patients with phyllodes tumours, 82.9% (n = 155) were classified as benign while 17.1% (n = 32) were borderline. Initial surgical margins were positive in 26.2% (n = 49), < 2 mm in 50.8% (n = 95), and ≥ 2 mm in 23% (n = 43) patients. Among patients with positive margins, 61.2% (n = 30) underwent margin revision. At a median follow-up of 2.9 years, the recurrence rate was 3.7%. On univariate analysis, only a positive margin at the time of initial surgery and not margin width was significantly associated with a higher rate of disease recurrence (hazard ratio [HR] 9.52, 95% confidence interval [CI] 1.85-49.2), as was a size greater than 4 cm on preoperative imaging (HR 10.78, 95% CI 0.97-120.1). Revision of an initially positive margin was not significantly associated with decreased local recurrence (p = 1). In this large cohort of benign and borderline phyllodes tumours, positive resection margins and not margin width at the initial surgery were associated with a increased recurrence. Individualization of decisions regarding margin reexcision is important.

A two-stage gap safe screening rule for multi-label optimal margin distribution machine

Multi-label optimal margin distribution machine (mlODM) is an efficient algorithm for multi-label classification. Although it can achieve great generalization performance, it is inefficient for large-scale datasets due to the huge number of label pairs. Motivated by its sparse solution, in this paper, we propose a two-stage gap safe screening rule for accelerating mlODM, termed as TSSR. First, a sequential safe screening rule (SSSR) based on gap is designed to screen out part of redundant label pairs prior to training, which reduces the scale of mlODM. Compared with the previous DVI rule, our method ensures absolute safety without destroying efficiency. In the second stage, to further speed up the solving process, a dynamic safe screening rule (DSSR) is embedded into the solving algorithm DCDM when training the simplified mlODM. More importantly, the feasible solution generated in the first stage can promote the efficiency of DSSR. To the best of our knowledge, this is the first attempt to create a hybrid screening rule for multi-label model. Our TSSR can greatly reduce the cost and achieve exactly the same accuracy. Experimental results on seven multi-label benchmark datasets and two real-world learning problems including movie genres classification and hypoglycemic drugs prediction verify the superiority of the proposed methods.

456 Multispectral imaging algorithm predicts Breslow tumor depth of malignant melanoma

Breslow tumor thickness is a major prognostic factor for melanoma. As it is based on histopathological evaluation, it is not available to aid clinical decision making at the time of the melanoma diagnosis. In this work, we assessed the efficacy of multispectral imaging (MSI) to predict Breslow tumor thickness and developed a melanoma classification algorithm to determine the optimal surgical safety margins. First, we excluded nevi from the analysis with the use of a novel quantitative parameter.

Clinical management of melanocytic tumours of uncertain malignant potential (MelTUMPs), including melanocytomas: A systematic review and meta-analysis.

Little guidance is currently available for managing patients with melanocytic tumours of uncertain or low malignant potential (MelTUMPs, including melanocytomas), in particular the optimal excision margins and whether to offer sentinel node biopsy (SNB). The objective of this review was to evaluate excision margins and the prognostic utility of SNB by systematic review of the literature and meta-analysis. PRISMA guidelines were followed. Medline, EMBASE and Cochrane databases were searched to October 2021 for studies of patients with MelTUMPs reporting excision margins and/or SNB-positivity. Meta-analysis was performed on the SNB-positivity rate using a random effects model, followed by sensitivity analyses on subgroups. 111 primary studies reported excision margins and/or SNB data for 1962 patients. Follow-up was available for 1649 patients: 1561 (94.7%) were alive without disease at last review, 53 (3.2%) had developed further disease, 29 (1.8%) had died of metastatic disease (melanoma) and six (0.4%) died of unrelated causes. SNB was performed in 837 patients. The pooled positivity rate on meta-analysis was 32% (95% CI: 23-44%). Clinical outcome could be correlated with excision margin in only 171 patients (60% of those with known follow up) and was therefore not analysed further. Evidence indicating the ideal excision margins for MelTUMPs was lacking. SNB had a high positivity rate despite very low rates of recurrence or melanoma-related death. Consequently, SNB should not be offered routinely for MelTUMPs (including melanocytomas), due to its lack of prognostic utility for this tumour type (high certainty of evidence).

Spare the Bowel, Don't Spoil the Target: Optimal Margin Assessment for Online Cone Beam Adaptive Radiation Therapy (OnC-ART) of the Cervix

PurposeThe standard treatment for locally advanced cervical cancer involves pelvic chemoradiation. Intensity modulated radiation therapy planning requires expansion of the cervix and uterus clinical target volume (CTV) by 1.5 to 2 cm to account for motion. With online cone beam adaptive radiation therapy (OnC-ART), interfractional movement is accounted for, which can potentially lead to smaller CTV to planned target volume (PTV) margins. In this study, we attempted to determine the optimal CTV-to-PTV margin for adequate coverage with OnC-ART and factors that can affect CTV coverage. Methods and MaterialsA retrospective cohort of 21 patients with cervical cancer treated with definitive chemoradiation was included. Nine patients treated with nonadaptive radiation had the uterocervix contoured on pretreatment cone beam computed tomography (CBCT) and end-treatment CBCTs. Anterior-posterior, lateral, and superior-inferior shifts and the average shift in all directions were calculated. A CTV-to-PTV expansion was determined and verified on a validation cohort of 12 patients treated with OnC-ART. ResultsThe average anterior-posterior, lateral, and superior-inferior shifts with standard deviation were 0.32 ± 1.55 cm, 0.12 ± 2.31 cm, and 1.67 ± 3.41 cm, respectively. A uniform 5-mm expansion around the pretreatment CTV covered 98.85% ± 1.23% of the end-treatment CTV. This 5-mm expansion was applied to our validation cohort treated with OnC-ART, and 98.39% ± 3.0% of the end-treatment CTV was covered. Time between CBCTs >30 minutes and change in bladder volume were significantly correlated to CTV coverage. ConclusionsBased on our analysis, a CTV-to-PTV margin of 5 mm is adequate to encompass 98% of the CTV. A significantly reduced margin could potentially decrease the toxicities associated with radiation for patients with cervical cancer and lead to improved patient reported toxicity outcomes. We recommend physicians begin with a 5-mm margin and assess adequate coverage with image guidance during daily adaptation.

Rebound stabilization for an asteroid lander by flexible plate design

Landing on small bodies like asteroids encounters great rebound uncertainties, which threatens the surface exploration and operation. This paper explores a potential solution for rebound stabilization through innovative flexible design of future landers. Specifically, we study a representative structure that assumes a flexible plate underneath current rigid landers (abbreviated as “FlexLander”). The plate is assigned to conform to the ground surface and provide large contact area. We develop an efficient dynamical model and carry out landing simulations, to reveal the lander's motion behavior and energy dissipation mechanism, also to provide instructions for the plate stiffness design. It is found that the deformable plate can remarkably tune the microgravity contact, and its stiffness exists a margin for design optimization and regulating. Finally, rebound stability of the proposed lander is evaluated over various landing attitudes, which can be found superior to that of rigid structure. The adaptivity to the rugged terrains and the up-righting requirement are also discussed for possible landing situations.

Optimization of Static Voltage Stability Margin Considering Uncertainties of Wind Power Generation

An optimal static voltage stability margin (SVSM) control model considering the uncertain wind farm output is proposed, in which the probability distribution of SVSM is required to satisfy the chance and variance constraints. A probabilistic distribution control method is proposed to solve the model. First, a linear weighted sum of B-spline basic functions is introduced to approximate the analytical function between the probability density function (PDF) of SVSM and control variables. Next, the analytical expression of the PDF of SVSM corresponding to a control variables’ sample is derived, and the sample of corresponding B-spline function weights is obtained, thus forming a series of ‘control variables-weights’ samples. Then, the analytic functions between weights and control variables are obtained using the generated samples to train a radial basis function neural-network, and the analytical function between the PDF of SVSM and control variables is obtained. After that, the chance and variance constraints are transformed into general nonlinear constraints with respect to control variables. Moreover, a method of selecting key control variables by calculating sensitivities is proposed to increase computational efficiency. Test results on the IEEE-39 bus system and an actual provincial power grid demonstrate the feasibility and effectiveness of the proposed method.

64 (PB-064) Poster - Borderline phyllodes tumors do not require wide resection margin

Background: Phyllodes tumor (PT) is a rare fibroepithelial neoplasm of the breast that can be classified as benign, borderline, or malignant. Conventionally, surgical margins of greater than 1 cm are recommended for all types of PT; however, the optimal extent of margin is still under debate. This study aims to investigate the optimal surgical margin to prevent recurrence after surgery for PT and to evaluate risk factors for local recurrence (LR).

Prognosis of tongue squamous cell carcinoma associated with individual surgical margin and pathological features

The specific muscular structure of the tongue greatly affects margin shrinkage and tumor invasion, making the optimal surgical margin controversial. This study investigated surgical margin correlated prognosis of TSCC (tongue squamous cell carcinoma) according to margin location and its value, and the histopathologic factors which are suggestive of tumor invasion. And we would like to propose defining of the surgical margin for TSCC via prognosis according to location and margin values. We reviewed 45 patients diagnosed with TSCC who visited Seoul National University Dental Hospital (SNUDH) (Seoul, Republic of Korea) from 2010 to 2019, who were managed by a single surgical team. Patient clinical and pathological data of patients were retrospectively reviewed, and in 36 out of 45 patients, the pathologic parameters including the worst pattern of invasion (WPOI) and tumor budding were investigated via diagnostic histopathology slide reading. When standardized with as 0.25 cm anterior margins, as 0.35 cm deep margin, there was no significant difference in disease specific survival (DSS) or loco-regional recurrence-free survival (LRFS). Additionally, there was a non-significant difference in DSS and LRFS at the nearest margin of 0.35 cm (PDSS=0.276, PLRFS=0.162). Aggressive WPOI and high tumor budding showed lower survival and recurrence-free survival, and there were significant differences in close margin and involved margin frequencies. In TSCC, the value and location of the surgical margin did not have a significant relationship with prognosis, but WPOI and tumor budding suggesting the pattern of muscle invasion affected survival and recurrence-free survival. WPOI and tumor budding should be considered when setting an optimal surgical margin.

Can jumps improve the futures margin level? An empirical study based on an SE-SVCJ-GPD model

In addition to the characteristics of leptokurtic fat-tailed distribution, financial sequences also exhibit typical volatility and jumps. Moreover, jumps exhibit self-exciting and clustering characteristics under extreme events. However, studies on dynamic margin levels often ignore jumps. In this study, we combine the self-exciting stochastic volatility with correlated jumps (SE-SVCJ) model with a generalized Pareto distribution (GPD) to measure the optimal margin level for the stock index futures market. Value at risk (VaR) is estimated and forecasted using the SE-SVCJ-GPD, SVCJ-GPD, and generalized autoregressive conditional heteroskedasticity with GPD (GARCH-GPD) models. SE-SVCJ-GPD can undertake more risks in the long or short trading position of stock index futures contracts. Moreover, the backtesting experiment results show that the SE-SVCJ-GPD model provides a more accurate margin level forecast than the other methods in both positions. This study’s findings have practical significance and theoretical value for assessing the level of risk and taking corresponding risk-prevention measures.

Time Dependence of Coverage of the Prostatic Fossa: Implications for Daily Adaptive Radiotherapy

<h3>Purpose/Objective(s)</h3> Online daily adaptive radiotherapy (ART) is an attractive modality for reducing PTV margins and improving the therapeutic ratio through elimination of inter-fractional uncertainty. However, daily adaptation is more time consuming than traditional image-guided radiation, and consequently, this increased time from initial CBCT acquisition until treatment delivery may introduce additional setup errors. For example, when delivering postoperative radiotherapy to the prostatic fossa, the adjacent bladder and rectum can change shape in the time required to adapt patients, resulting in deformation of the target and potentially a geographic miss. Therefore, we hypothesized that decreased time between scans would be associated with better coverage. <h3>Materials/Methods</h3> A single-center retrospective study was conducted from 03/2021 to 11/2021. Patients receiving conventionally fractionated radiotherapy to their prostatic fossa +/- elective nodes with pre- and post-treatment CBCT imaging before and after the same fraction (CBCTpre and CBCTpost, respectively) were included. Clinical target volumes (CTVpre and CTVpost) were contoured by a single observer on all CBCTs (only the prostatic fossa CTV was analyzed in this study). CBCTpre and CBCTpost images were registered using the same shifts from the day of treatment. Overlap of CTVpre and CTVpost was calculated and correlated with time with Pearson's correlation coefficient. The time threshold at which the maximum difference in overlap of CTVpre and CTVpost was identified iteratively. Subgroups above and below this threshold were compared, evaluating the percent overlap between CTVpre with 1, 2, and 3 mm expansions with CTVpost (here, overlap serves as a surrogate of dose coverage). <h3>Results</h3> When evaluating overlap between CTVpre and CTVpost, there was a trend towards more overlap with shorter intervals between scans (r=-0.091). A threshold of 13.5 minutes was identified with scans <13.5 minutes apart (n=210) having an average overlap of 91.4% vs ≥13.5 minutes (n=32) being 89.2% (p = 0.026). However, this difference lost significance when using 3 mm PTV margins (p=0.134), which was previously shown to be the optimal margin for this cohort. Still, there was a suggestion of better coverage for intra-scan times <13.5 minutes for all margins evaluated: 1mm (75.7% vs 59.4% achieved 95% coverage), 2mm (93.3% vs 84.4%), and 3mm (98.1% vs 90.6%). <h3>Conclusion</h3> Shorter times utilized for daily adaptation of the prostatic fossa may be associated with better coverage, likely secondary to less displacement of the target from patient movement and deformation from changes in adjacent normal tissue. Given image sets with intra-scan times >13.5 minutes were limited in this study, these findings will need to be validated in larger prospective cohorts.

Coupled Embedding Networks for 7-dB Gain-per-Stage at 130–140 GHz in a 20-dBm Gallium Nitride Power Amplifier

We propose a coupled embedding network (CEN) as a portable, robust design technique to simultaneously introduce gain boosting and loadline matching in millimeter-wave power (mm-wave) amplifiers (PAs). The approach uses directional couplers as an abstraction for the embedding network and produces straightforward design equations to achieve optimal input-stability margins for any specified gain. We demonstrate the design process and implementation using a 40-nm Gallium Nitride (GaN) process technology through simulated and measured performance of the PA with and without the embedding network. The output power is greater than 20 dBm and remains above 18 dBm over an 8 GHz bandwidth. Peak power added efficiency (PAE) is 6.5%. The 3-stage PA achieves 21 dB of gain at 137 GHz offering 7.1-dB gain per device. The measured gain is 8 dB higher than the common-emitter design with the same number of stages. To our knowledge, this is the highest gain per stage for a GaN PA in D-band.

Usefulness of Shear Wave Elastography in Determining the Tumor Extent of Basal Cell Carcinomas.

The purpose of this study was to investigate the value of shear wave elastography (SWE) in determining tumor extent of basal cell carcinomas (BCC), and thereby determine the optimal surgical margins (OSM). 10 patients (40 surgical margins) with BCC were collected, the visual observation boundaries (VOB) were marked, and the SWE parameters of soft tissues were measured 1 mm intervals in "3, 6, 9, 12" clock directions, starting from VOB. Then tumors were resected with a 5 mm surgical margin outward expansion of VOB. All specimens were examined pathologically 1 mm intervals from VOB in four clock directions. With the positive margins furthest from the tumor as the real tumor boundaries (RTB) and the negative margins closest to the tumor as the optimal surgical margins (OSM). The SWE parameters were compared between these two groups. The elasticity ratio (Eratio ) of average young's modulus between region of interest and adjacent normal soft tissue had statistically significant differences between groups (P= .000), while other parameters show no difference. The Eratio of RTB and OSM were 1.22 ± 0.14 and 0.99 ± 0.07. The area under the ROC curve was .947. Taking 1.075 as the threshold of Eratio for the diagnosis of tumor extent, the sensitivity, specificity and accuracy were 87.5%, 90.0% and 90.0%. The surgical margins designed according to OSM were better than those designed according to VOB +5 mm (P= .000). The Eratio of SWE is helpful in determining tumor extent of BCC. This is beneficial for surgical margin designing.

33979 Minimum resection margins for fibrohistiocytic tumors: A systematic review to inform a probability model

Background: Atypical fibroxanthomas (AFX) and cutaneous undifferentiated pleomorphic sarcomas (cUPS) are fibrohistiocytic tumors with significant clinical and histologic overlap. The metastatic potential of both pathologies necessitates treatment with either wide local excision (WLE) or Mohs micrographic surgery (MMS) to attain margin clearance. Few studies have investigated the optimal resection margins in WLE or the first stage of MMS when treating AFX or cUPS, and currently no recommendations exist.