Surgical Margins Research Articles

Organ-confined prostate cancer with negative surgical margins in an entirely-embedded radical prostatectomy is essentially non-lethal-a retrospective single-institutional study of 520 patients.

There is no risk-based stratification in serum PSA monitoring in prostate cancer (PCa) patients following radical prostatectomy (RP). Those patients with minimal risk of recurrence may be subjected to unnecessarily rigorous monitoring as well as to increased anxiety disproportionate to their actual prognosis. This study aimed to investigate outcomes in PCa patients with favorable pathologic parameters to see whether they can be followed less rigorously than current practice recommendations dictate. 520 consecutive entirely embedded organ-confined RPs with negative margins and undetectable initial postoperative serum PSA at the University of Chicago Medical Center between 2005 and 2017 were retrospectively identified. Clinicopathologic parameters and follow-up data including serum PSA were analyzed. No patients, regardless of their grade group (GG), developed metastasis or succumbed to a PCa-specific death. These patients had a median postoperative follow-up of 109months. 2.2% (22/520) of the patients developed biochemical recurrence (BCR). There were 163, 279, 69, 4, and 5 RPs from GG 1 to 5, respectively. Of these, 0% (0/163), 1.8% (5/279), 18.8% (13/69), 0% (0/4), and 60% (3/5) developed BCR, sequentially. In this study, organ-confined PCa with negative margins in an entirely embedded RP carried no mortality risk. In particular, the patients with GG 1-2 disease may have benefited from less rigorous monitoring. Additionally, enhanced patient reassurance could play a role in reducing anxiety in this subset of patients.

Wide surgical margins may be necessary to reduce recurrence and mortality in patients with localized periosteal chondrosarcoma: retrospective analysis of twenty three patients and literature meta-analysis.

Periosteal chondrosarcoma (PCS) is the rarest subtype of chondrosarcoma and is recognized as a low-grade malignant tumour, reported to have an 88% ten year overall survival rate. The relationship between surgical margins and clinical outcome is inconsistent; some authors claim that PCS can be successfully treated with marginal resection and others report more local recurrence and distant metastasis with marginal compared to wide resection. This study was intended to report the treatment and prognosis of localized PCS patients from the Japanese National Bone and Soft Tissue Tumor Registry database and to perform a systematic review of the literature to determine the relationship between surgical margins and rates of local recurrence, distant metastasis, and mortality. Twenty-three patients with pathologically-diagnosed PCS between 2006 and 2022 from the Japanese National Bone and Soft Tissue Tumor Registry database were retrospectively analyzed. Of the 105 studies found through a systematic search using Pubmed, Embase, and Cochrane Central Register of Controlled Trials databases, nine studies were ultimately included. The local recurrence rate after R0 resection was 2.5% (3/118 patients) and after R1 resection was 33.3% (11/33 patients) (p < 0.001). The distant metastasis rate in the R0 resection group was 5.9% (7/118 patients) and in the R1 resection group was 27.3% (9/33 patients) (p = 0.010). Mortality following R0 resection was 4.2% (5/118 patients) but after R1 resection was 18.2% (6/33 patients) (p = 0.040). Wide resection may be necessary for localized PCS to prevent local recurrence and distant metastasis and improve survival.

Primary Epithelioid Angiosarcoma of the Penis: A Case Report With a Brief Review of the Literature

Abstract: Angiosarcoma of the penis is an exceptionally rare mesenchymal tumor, with only about 30 cases documented in the literature. Because of its rarity and the often nonspecific clinical presentation, histopathological examination plays a critical role in accurate diagnosis. Angiosarcoma of the penis typically arises in the corpus cavernosum but has also been reported in the glans and urethra, often presenting with metastases. This report details a case of epithelioid angiosarcoma of the penis in an 84-year-old man, who presented with a rapidly enlarging, violaceous nodule on the glans penis. Histopathology revealed atypical epithelioid endothelial cells with pleomorphism and mitotic activity, and immunohistochemical markers such as CD31, Erythroblast transformation-specific [ETS]-related gene, and cellular myelocytomatosis oncogene confirmed the malignant endothelial neoplasm. The differential diagnosis excluded conditions such as epithelioid hemangioendothelioma and Kaposi sarcoma. Because of the rarity, standardized treatment protocols are lacking; however, wide excision with tumor-free margins and the potential for targeted therapies based on gene amplification are considered important. The review highlights the diagnostic challenges, prognostic factors, and current therapeutic approaches, emphasizing the need for further research to develop standardized treatment protocols.

Partial penectomy with reconstruction using a split-thickness skin graft: a multicenter experience.

Penile cancer is a relatively rare neoplasm in developed countries, with the majority of newly diagnosed cases presenting as organ-confined, with a 5-year survival rate of 90%. Therefore, it is crucial to consider the impact of penile tumor resection on sexual and urinary function. Regrettably, the literature is devoid of comprehensive, step-by-step video instructions for the surgical procedure of partial penectomy with reconstruction using a split-thickness skin graft (0.3 mm). This study aimed to demonstrate a step-by-step video of the partial penectomy technique with reconstruction using a split-thickness skin graft and to present the outcomes of this procedure. This multicenter study was initiated in April 2019 and completed in February 2023, enrolling 54 male patients who underwent partial penectomy and reconstruction using a split-thickness skin graft (0.3 mm). The study collected data on the local recurrence rates, overall survival, sexual and voiding functions and complications. The average patient age was 61.26 years old (range: 26-82 years). Following penile-sparing surgery, a substantial proportion of patients exhibited favorable results. Among the 54 patients, 37 (68.5%) were classified as sexually active and 50 (92.6%) demonstrated good voiding function. Excellent cosmetic outcomes were achieved in 52 patients (96.3%), and the average size of the negative resection margins was 4.75±4.162 mm (range: 0.5 to 20 mm). Notably, no positive margins were observed. Patient outcomes depend on the tumor stage and histologic grade rather than the size of the surgical margin. Partial penectomy with reconstruction using a split-thickness skin graft has excellent oncological, functional, and cosmetic outcomes.

Therapeutic implications of narrow or positive surgical margins in head and neck tumors

IntroductionThe treatment of squamous cell carcinomas of the head and neck region involves a multidisciplinary approach that combines surgery, radiotherapy and chemotherapy.AimThe aim of this article is to discuss the therapeutic implications of narrow or positive surgical margins in head and neck cancers.Material and methodsThe article was written based on the analysis of the literature on the subject.Results and discussionSurgical resection is an important part of a approach to treatment and the adequacy of resection during surgery is determined by the margin status. A margin greater than 5 mm is considered free, less than 5 mm - narrow, and less than one mm is considered positive. For proper planning of radiotherapy, i.e. adequate selection of areas and doses, the following are necessary: imaging, endoscopy, pathology report. It should also be remembered that the lack of important information from the treatment and the fear of making a geographical error and/or not matching the dose to the actual stage of the disease and the status of the margins; affects the decision of the radiotherapist who will escalate the dose, which may lead to long-term tissue damage with loss of their function and significantly affect the quality of life of these patients.ConclusionsBefore initiating treatment, each patient should undergo analysis in multidisciplinary consultations to tailor the optimal therapeutic decision to the stage of the disease and any coexisting conditions.Patients with advanced disease and/or challenging localization and/or rare disease diagnoses should be treated in highly specialized centers where close collaboration between facilities is essential.

Clinical validation on role of cancer diagnostic probe in detecting the involved cavity margins missed in permanent pathology of tumor side in breast cancer surgery

Cancer diagnostic probe (CDP) as a newly entered tool in real-time breast cavity margin evaluation showed great improvement in smart margin shaving intra-operatively. This system increased the rate of involved margin detection to 30% with respect to frozen section. In this study for the first time we showed the independent role of CDP in finding the involved cavity side margins which were not diagnosed by permananet pathology of their tumor side interface. Among 147 detected margins by CDP, 23 lesions with invasive component and ductal carcinoma in-situ/ductal cancerization weren’t reported as involved margins in permanent pathology of tumor side. Our gold standard was the histology of cavity margin specimen had been scored as involved lesion by CDP. It seems that even when the permanent pathology of surgical margins is used for final declaration, role of CDP is irreplaceable. This distinguished achievement has been obtained intra-operatively in real-time by CDP while involved report in permanent pathology of tumor margins induce re-surgery for the patient.

Solitary fibrous tumor of the gallbladder: a case report

BackgroundPrimary solitary fibrous tumors (SFTs) of the gallbladder are rare. Here, we report the case of a patient who underwent surgical treatment for a primary SFT originating in the gallbladder.Case presentationA 48-mm gallbladder tumor was detected in a 70-year-old man using abdominal ultrasonography at a primary hospital, and he was subsequently referred to our department. A 50-mm enhanced tumor in the gallbladder was identified using computed tomography. Magnetic resonance imaging revealed a smooth-marginated tumor with hyperintensity on T2-weighted imaging. 18F-Fluorodeoxyglucose positron emission tomography confirmed high-level fluorodeoxyglucose uptake in the gallbladder tumor in the early phase without increasing uptake in the later phase. Surgical resection was planned to evaluate the tumor diagnosis. Initially, we performed open cholecystectomy with wedge resection of the gallbladder bed. Intraoperative pathological examination suggested gallbladder cancer; therefore, we performed radical surgery, including resection of the common bile duct, extended radical lymphadenectomy, and choledochojejunostomy. Ultimately, the final pathological examination revealed an SFT originating from the gallbladder with a negative surgical margin. Postoperatively, the patient developed bile leakage that was treated with tube drainage. The patient recovered satisfactorily and was discharged on postoperative day 20. At 24 months postoperatively, the patient was in good general condition without recurrence.ConclusionsWe report a rare case of a primary SFT originating in the gallbladder. Clinicians should be aware that SFT can be found in the gallbladder, and when it is difficult to make a preoperative diagnosis, surgical treatment should be considered.

Methods for 3D evaluation and quantification of gingival recessions and gingival margin changes: Advancements from conventional techniques

AbstractIn an era of increasing life expectancy and growing patient demands towards lifelong natural tooth retention, accurate assessment of gingival recessions is crucial for diagnosing periodontal diseases, planning preventive or restorative interventions, and evaluating their outcomes. The traditional two‐dimensional (2D) methods, while useful, often fall short in capturing the complex topography of gingival tissue margins and their changes over time. By examining relevant published studies, this review highlights the transition from 2D to 3D techniques, analyzing the limitations of widely used 2D approaches, while emphasizing the potential of novel 3D tools and techniques. It discusses their comparative effectiveness, accuracy, and application challenges in clinical and research settings. Advancements in three‐dimensional (3D) imaging regarding methodologies for the precise evaluation and quantification of free gingival margin changes and gingival recessions are explored and critically evaluated. The review underscores the potential for these technologies to enhance patient outcomes through more precise diagnosis and data generation. It also identifies gaps in current research and suggests directions for future investigation. Overall, this review provides a comprehensive overview of the state of the art in 3D evaluation methods for gingival recessions and gingival margin changes, offering valuable insights for clinicians and researchers.

Fluorescence confocal microscopy for margin assessment in prostatectomy: IP8-FLUORESCE study protocol.

Radical prostatectomy (RP) represents the cornerstone of surgical treatment for prostate cancer. Assessing surgical margin status intraoperatively with current techniques remains challenging due to high costs in the context of an already stretched pathology workforce. Fluorescence confocal microscopy (FCM) is a promising technique to detect margins in prostate cancer surgery not bound by such limitations. The Imperial Prostate 8 - Fluorescence Confocal Microscopy for Rapid Evaluation of Surgical Cancer Excision (IP8-FLUORESCE) study is a multicentre, prospective, ex vivo, 'blinded', comparative cohort study. It aims to assess the accuracy of digital FCM for detection of prostate cancer at surgical margins compared to traditional histopathology. The primary endpoint is the accuracy of digital FCM for detection of prostate cancer at surgical margins on a per-patient level, reported with sensitivity, specificity, positive and negative predictive values. A total of 153 patients with localised prostate cancer undergoing robot-assisted RP across three UK National Health Service tertiary referral centres will be recruited. Following RP, prostate specimens will undergo immediate immersion in Acridine Orange solution, scanning 'en face' with FCM using the Histolog® Scanner, and subsequent formalin fixation and paraffin embedding. Two independent, 'blinded' uro-pathologists will report both the FCM images and the histopathology slides. Recruitment commenced on 17 August 2023.

Anatomic and Reconstructive Considerations During Gastric GIST Resection

Gastric gastrointestinal stromal tumors (GISTs) are the most common type of GISTs in the gastrointestinal tract. Gastric GISTs may present in a wide variety of sizes and locations in the stomach. The goal of the surgical and/or endoscopic treatments is a complete R0 resection with free margins, and combined methods to accomplish this resection are available. This manuscript will review the various surgical and/or endoscopic techniques available and the technical considerations for appropriate gastric GIST resections.

POORLY DIFFERENTIATED CLUSTERS IN COLORECTAL CARCINOMA: ASSOCIATION WITH OTHER HISTOPATHOLOGICAL PROGNOSTIC PARAMETERS INCLUDING TUMOUR BUDDING

Objective: In India, colorectal carcinoma (CRC) ranks third in terms of cancer incidence. Pathologists are essential when it comes to determining the stage, examining surgical margins, and recording the histopathologic prognostic factors. A new prognostic grading system is proposed named poorly differentiated clusters (PDCs), which are defined by neoplastic clusters of 5 cells lacking glandular structure in the invasive front of the stroma. It is significant for cancer-specific and recurrence-free survival in CRC patients, reflecting the biological aggressiveness of the tumor. Aim of the study was to analyse of PDCs in colorectal carcinomas and association with other histopathological prognostic factors. Methods: The Hematoxylin and Eosin (HandE)-stained slides of 76 histopathologically diagnosed CRC resection specimens were reviewed. Poorly differentiated clusters (PDC) were assessed into under 200x power. The correlation of PDC with other histopathological prognostic parameters like tumor size, site, grade, laterality, lymphovascular invasion, perineural invasion, T stage, N stage, and tumor budding was analyzed using descriptive statistics and the Chi-square test with SPSS version 26.0. Results: There was no significant association between PDC and age, tumor location, tumor size, histological grade, LVI, PNI, or lymphnode status. Where a significant association was noted between the sex and PDC grade (P value = 0.035), T stage and PDC grade (P value = 0.045), and N stage and PDC grade is significant (P value = 0.001). Conclusion: PDCs may be considered, along with other clinical-pathological parameters, a promising prognostic factor for the management of patients with CRC and should be included in pathological reports, but it still needs standardization and further validation. At the same time, tumor budding can become an irreplaceable histological indicator for identifying a high malignant potential carcinoma and poor prognosis in CRCS, thus indicating the need for aggressive postoperative management to improve the prognosis of the patient. PDC is important for the survival of CRC patients, indicating the aggressiveness of the tumor both in terms of cancer-specific survival and freedom from recurrence. PDC may help to identify patients who need a more intensive postoperative follow-up and the possibility of adjuvant therapy.

Nomograms Predicting Survival, Recurrence and Beneficiary Identification of Adjuvant Chemotherapy in Treatment-naïve Patients with Rectal Cancer who Underwent Upfront Curative Resection: A multi-institutional study

Objective: To create and validate nomograms predicting overall survival and recurrence in treatment-naïve rectal cancer (RC) patients who underwent upfront surgery. Background: Although multidisciplinary treatment is standard for locally advanced RC, understanding surgical efficacy is important for determining indications for perioperative adjuvant therapy. Methods: RC patients who underwent upfront surgery at the Japanese Society for Cancer of the Colon and Rectum institutions were analyzed. A training cohort (n = 1925) of treatment-naïve patients who underwent surgery between 2007 and 2008 was analyzed to construct prognostic models predicting postoperative survival and recurrence. Discrimination and calibration were performed using an external validation cohort (n = 2957; Japanese colorectal cancer registry, procedures in 2005–2006). Effects of adjuvant chemotherapy on survival were evaluated based on nomogram prediction and Surveillance, Epidemiology, and End Results (SEER) data (n = 10,482; upfront surgery for RC in 2010–2015). Results: In the training cohort, age predicted survival, venous invasion predicted recurrence, and sex, tumor location, histological type, preoperative carcinoembryonic antigen, invasion depth, lymphatic invasion, positive radial margin, and numbers of metastatic nodes and examined nodes predicted both. Internal and external validated Harrell’s C-index values were respectively 0.77 and 0.75 for survival and 0.75 and 0.74 for recurrence. RC patients who underwent upfront surgery in the SEER database were stratified into 3 risk levels by nomogram score. Adjuvant chemotherapy did not improve 5-year survival in low-risk patients, but did so for middle-risk (62.4% vs 76.8%) and high-risk (39.4% vs 63.5%) patients. Conclusion: These nomograms could predict survival and recurrence after upfront curative resection of RC and identify cases expected to benefit more from adjuvant chemotherapy.

Trends and Outcomes of Neoadjuvant Chemotherapy for Clinical Stage T1 Pancreatic Cancer.

Neoadjuvant chemotherapy (NC) for early pancreatic ductal adenocarcinoma (PDAC) remains controversial. We investigate the adoption of NC and its impact on survival in clinical T1 (cT1) PDAC. National Cancer Database (2006-2017) was reviewed for cT1 PDAC. Patients receiving NC and surgery were compared with patients undergoing upfront surgery (US). A total of 5886 patients were included. NC use increased from 4.8% in 2006 to 18.8% in 2017. The NC group (n = 618) versus the US group (n = 5268) had: younger age (66 years vs. 68 years), smaller tumor size (2 cm vs. 2.2 cm), more pancreas head tumors (77% vs. 70.6%), lower lymph-vascular invasion (25.9% vs. 40.6%), and less lymph node positivity (43.6% vs. 54.5%), p < 0.001. Factors associated with receipt of NC were: younger age, recent year of diagnosis, and treatment at an academic program. In the NC group versus the US group, median OS was 35.2 months versus 28.3 months, p < 0.001. Factors associated with improved survival included: well differentiated pathology, R0 surgical margins, and receipt of chemotherapy. In cT1 PDAC, chemotherapy is associated with improved survival. In a surgery-first approach, only 59% of patients receive adjuvant chemotherapy. These data suggest consideration of neoadjuvant therapy for early pancreatic cancer.

Performance of an AI-powered visualization software platform for precision surgery in breast cancer patients

Surgery remains the primary treatment modality in the management of early-stage invasive breast cancer. Artificial intelligence (AI)-powered visualization platforms offer the compelling potential to aid surgeons in evaluating the tumor’s location and morphology within the breast and accordingly optimize their surgical approach. We sought to validate an AI platform that employs dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to render three-dimensional (3D) representations of the tumor and 5 additional chest tissues, offering clear visualizations as well as functionalities for quantifying tumor morphology, tumor-to-landmark structure distances, excision volumes, and approximate surgical margins. This retrospective study assessed the visualization platform’s performance on 100 cases with ground-truth labels vetted by 2 breast-specialized radiologists. We assessed features including automatic AI-generated clinical metrics (e.g., tumor dimensions) as well as visualization tools including convex hulls at desired margins around the tumor to help visualize lumpectomy volume. The statistical performance of the platform’s automated features was robust and within the range of inter-radiologist variability. These detailed 3D tumor and surrounding multi-tissue depictions offer both qualitative and quantitative comprehension of cancer topology and may aid in formulating an optimal surgical approach for breast cancer treatment. We further establish the framework for broader data integration into the platform to enhance precision cancer care.

OGC SO33 - Resection Margins in Gastrectomy Patients – Are Current Guidelines Fit for Purpose? An Observational Study from a Tertiary Centre

Abstract Background Positive resection margins in cancer surgery are associated with higher likelihood of locoregional recurrence and poor outcomes. The Association of Upper GI Surgeons (AUGIS) outlined a target of less than 5% margin positivity for gastric resections, a goal not met in repeated national audits (NOGCA). Our study aimed to evaluate the positive resection margin rate after a gastrectomy in a tertiary centre and identify associated factors to assess the current guideline's suitability. Our hypothesis is that positive longitudinal margins are more related to tumour factors, such as proximity to the intended margin, rather than poor surgical technique. Method All records of patients who underwent gastrectomy from June 2015 to September 2021 were retrospectively reviewed. Data collection included demographic details, type of gastrectomy, exposure to neoadjuvant chemotherapy, and post operative histopathological information such as tumour differentiation, presence of signet ring (SR) morphology and linitis-plastica (LP), and resection margin(RM) status. Chi square tests of association were utilised to determine associations between the resection margin status and the potential determinant factors. Results Our study included 144 subjects (100 males, mean age 66, range 27-87). Types of gastrectomy were subtotal (38.9%), proximal (4.2%), total (29.2%), extended total (ETG) (27.8%). Positive RMs were found in 13.2%, with 8.3% having positive longitudinal margins and 6.3% positive circumferential margins. Neoadjuvant-chemotherapy was completed by 73% of subjects. Poor tumour differentiation was seen in 59.7%, SR presence in 12.5%, and LP in 3.5%. Significant associations were noted between positive margins and LP (80%, p&amp;lt;0.001) and age (&amp;lt;65: 15%, &amp;gt;=65: 4%, p=0.028). ETGs had double the rate of positive margins (12.5%) than that of other gastrectomies (6.7%,p=0.314). Conclusion The overall positive longitudinal margin rate was higher than the national guideline, replicating NOGCA audits. Our hypothesis was not proved: although the longitudinal positive margin rate in ETGs was almost double that of other gastrectomies, this did not reach statistical significance. Positive margin rates were higher in younger patients, and those with LP. Further large-scale audit is urgently required to determine if the recommended margin rate is appropriate or whether it should be adjusted for factors such as tumour location, presence of LP and age when the risk of a positive margin is higher.

OGC SO25 - Tumour Regression Grade (TRG) and Completeness of Resection in patients under esophagectomy for oesophageal Cancer

Abstract Background Oesophageal cancer, including squamous cell carcinoma (SCC) and adenocarcinoma, is challenging due to its aggressive nature and delayed presentation. Neoadjuvant chemotherapy aims to downstage the tumour thus aids in surgery and improves patient outcomes. Complete resection with tumour free resection margins is crucial for cure and survival. Understanding the relationship between tumour regression grade (TRG) and completeness of resection helps improve outcomes in patients with oesophageal cancer. Method This retrospective study was conducted over a period of 4 years (2019-2023). It included all patients over 18 years of age who underwent oesophagectomy for either squamous cell carcinoma (SCC) or adenocarcinoma following neoadjuvant chemotherapy. Tumour Regression Grade (TRG) was defined by the histological report while R1 resection was defined as any margin less than 1 mm. Statistical analysis was performed to evaluate the incidence of complete and incomplete resections across the various TRG groups. Results Study included 214 patients (178 males, 36 females) with a median age of 67 (31-82) years. Of the 214 patients, 201 (93.9%) had adenocarcinoma and 13 (6.1%) had SCC. Complete resection was achieved in 136 patients (63.6%), while 78 (36.4 %) had incomplete resections. TRG distribution in the complete resection group was-TRG 1 (97.6 %), TRG 2 (76.5 %), TRG 3 (67.2 %), TRG 4 (56.1 %), and TRG 5 (31.9 %). The Chi-Square test indicated significant associations between TRG and resection completeness (Chi-Square = 44.229, p &amp;lt; .001; Likelihood Ratio = 51.804, p &amp;lt; .001; Fisher's Exact Test p &amp;lt; .001). Conclusion The study demonstrates a significant correlation between higher TRG scores and incomplete resections in esophagectomy patients’ post-neoadjuvant chemotherapy. We conclude TRG is an important prognostic indicator for surgical outcomes in oesophageal cancer.

OGC SO04 - Impact of COVID-19 on Decision-making and Survival in Esophago-Gastric Cancer Treatment: Insights from a Multidisciplinary Approach

Abstract Background The COVID-19 pandemic necessitated rapid adaptation in healthcare delivery, affecting cancer care pathways. This study assesses the impact of these changes on multidisciplinary team (MDT) decision-making and survival outcomes in esophago-gastric cancer patients across pre-pandemic, peak pandemic, and post-pandemic periods. Method A retrospective cohort study involving patients referred to a UK tertiary EG cancer center during distinct six-month intervals mirroring the pandemic's evolution. Analysis focused on MDT recommendations, treatment pathways, and two-year survival rates, comparing deviations from standard care across periods. Results The study revealed a significant reduction in patient referrals and expedited treatment decisions during the pandemic peak, with a shift towards palliative care in post-pandemic cases. Although no statistically significant difference in two-year survival rates was observed, the post-pandemic period showed an increase in tumor aggressiveness and positive resection margins, suggesting potential long-term impacts of delayed diagnosis and treatment. Conclusion COVID-19 has significantly influenced MDT decision-making and patient pathways in esophago-gastric cancer care, underlining the necessity of resilient healthcare systems. Despite maintaining survival rates, the observed increase in tumor aggressiveness post-pandemic highlights the critical need for uninterrupted cancer diagnosis and treatment services during global health emergencies.

OGC O01 - Stomach Cancer Elective Surgery Morbidity and Mortality at 90-Days (HOLD Study): A Prospective, International Collaborative Cohort Study

Abstract Background Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes according to GASTRODATA Registry for elective gastric cancer surgery patients and identify risk factors. Method We conducted an international prospective study on ≥18 years patients undergoing elective surgery for gastric cancer with curative intent from 01 April 2022 to 30 September 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression was used to identify variables associated to 90-day outcome. Results 380 collaborators from 47 countries submitted data on 1538 patients. Mean age was 64.2 years and 58.5% were males. 90-day morbidity rate was 38.2% (n=587) and mortality rate was 2.9% (n=45). Pre-operative higher CCI or ASA score, pre-operative weight loss &amp;gt;10%, and surgical determinants such as type of gastric resection, positive specimen margin, number of harvested lymph nodes, longer surgery duration and post operative pathological IV staging (p value&amp;lt;0.05) were identified as predictors of postoperative severe complications and mortality. Conclusion Elective gastric cancer surgery has a 90-day morbidity of 38.2% and 90-day mortality of 2.9%, globally. This study identified several factors associated with higher morbidity and exemplified the importance of a unified language on surgical morbidity, pre-habilitation and ongoing audits to enhance patient outcomes.

In vivo reflectance confocal microscopy role for early to advanced lentigo maligna melanoma spectrum: A systematic review and pooled analysis.

Lentigo maligna (LM) is a growing problem worldwide and the main type of melanoma insitu in some Caucasian populations. It presents as a spectrum from atypical intraepidermal melanocytic proliferation (AIMP) to invasive lentigo maligna melanoma (LMM). Accurate diagnosis and staging are crucial for determining appropriate management strategies. To assess the role of invivo reflectance confocal microscopy (RCM) in differentiating early and advanced stages of lentigo maligna. A systematic search was conducted on Medline, PubMed, Scopus, Web of Science, Proquest Central, Embase, Cochrane and Google Scholar. References of included and excluded studies were reviewed for additional sources. Studies involving RCM for AIMP, LM and LMM diagnosis published until 1 December 2023, were selected for analysis. Publications on other non-invasive imaging techniques, other skin diseases or those addressing only RCM surgical margins and therapeutic response without reporting RCM features were excluded. Each article was reviewed by two experts, with disagreements resolved by a third expert. Data for each RCM feature were pooled, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Features were stratified for architecture, cellular morphology and distribution. Twenty-seven articles involving 303 lesions were included. Features favouring LM over AIMP included (1) Architecture: the presence of non-edged papillae (OR 4.50, 95% CI 1.92-10.52) and (2) Cellular distribution: widespread pagetoid cells and junctional atypical cells (OR 25.06, 95% CI 4.19-148.45) and junctional nests (OR 18.06, 95% CI 3.04-106.32). Features favouring LMM over LM included (1) Architecture: epidermal disarray (OR 5.03, 95% CI 1.90-13.22), junctional disarray (OR 4.19, 95% CI 1.54-11.33) and destroyed collagen fibres (OR 3.91, 95% CI 1.80-8.44) and (2) cellular distribution: widespread pagetoid and junctional atypical cells (OR 2.71, 95% CI 1.27-5.75) and junctional nests (OR 4.48, 95% CI 2.12-9.43). This study identifies the RCM features associated with the LM/LMM spectrum.

HPB SO24 - Recurrence Pattern of Pancreatic Ductal Adenocarcinoma based on Time-to-Recurrence: A 5-year Single-Centre Retrospective Study

Abstract Background A vast majority of patients with pancreatic ductal adenocarcinoma (PDAC) develop early disease recurrence, even after curative-intent surgical resection. Understanding the pattern of disease recurrence will enable identification of areas for improvement within the preoperative diagnostic and management algorithms for these patients. The aim of the retrospective cohort study was to compare the recurrence pattern of PDAC in patients with early (&amp;lt;12 vs &amp;gt;12 months) and very early (&amp;lt;6 vs &amp;gt;6 months) recurrence following surgical resection. Method A retrospective review of histologically confirmed pancreatic ductal adenocarcinoma patients who underwent pancreaticoduodenectomy (N=151) between 2015-2020 at a tertiary HPB centre was undertaken. All patients underwent CT and PET-CT for initial staging before resection. Initial recurrence after resection was identified through postoperative imaging and/or HPB MDT outcomes. Early recurrence (ER) was defined as recurrence within the first 12 months after surgery (n=78). Additionally, very early recurrence (VEM) was defined as recurrence within the first six months after surgery (n=46). Statistical analysis was performed using GraphPad Prism 8.0. Results In total, 117 (77.5%) of patients experienced recurrence, with a median recurrence-free survival of 11.3 (5.1-19.6) months. Patients with ER had significantly higher pathological T staging (p=0.01), greater margin positivity rate (p=0.01) and higher lymph node ratio (p=0.046), while those in VER had significantly larger maximum tumour diameter and number of involved lymph nodes (p=0.04) compared to their counterparts. Patients with ER (47.4 vs 31.5%, p=0.046) and VER (60.9 vs 30.5%, p&amp;lt;0.001) had significantly greater rates of liver metastasis compared to their counterparts. There were no differences in loco-regional recurrence, peritoneal or pulmonary metastasis between the groups. Conclusion Approximately 20% of patients undergoing surgical resection for PDAC developed liver metastasis within six months of surgery. This raises concerns for the presence of micro-metastatic disease within the liver unidentified on preoperative imaging. Therefore, there is a need to enhance preoperative imaging and treatment algorithms to improve survival of patients with PDAC.