Surgical Margins In Patients Research Articles

Impact of Prostate Weight on Probability of Positive Surgical Margins in Patients With Low-risk Prostate Cancer After Robotic-assisted Laparoscopic Radical Prostatectomy

To evaluate the impact of prostate weight (PW) on probability of positive surgical margin (PSM) in patients undergoing robotic-assisted radical prostatectomy (RARP) for low-risk prostate cancer. The cohort consisted of 690 men with low-risk prostate cancer (clinical stage T1c, prostate-specific antigen <10 ng/mL, biopsy Gleason score ≤6) who underwent RARP with bilateral nerve-sparing at our institution by 1 of 2 surgeons from 2003 to 2009. PW was obtained from the pathologic specimen. The association between probability of PSM and PW was assessed with univariate and multivariate logistic regression analysis. A PSM was identified in 105 patients (15.2%). Patients with PSM had significant higher prostate-specific antigen (P = .04), smaller prostates (P = .0001), higher Gleason score (P = .004), and higher pathologic stage (P < .0001). After logistic regression, we found a significant inverse relation between PSM and PW (OR 0.97%; 95% confidence interval [CI] 0.96, 0.99; P = .0003) in univariate analysis. This remained significant in the multivariate model (OR 0.98%; 95% CI 0.96, 0.99; P = .006) adjusting for age, body mass index, surgeon experience, pathologic Gleason score, and pathologic stage. In this multivariate model, the predicted probability of PSM for 25-, 50-, 100-, and 150-g prostates were 22% (95% CI 16%, 30%), 13% (95% CI 11%, 16%), 5% (95% CI 1%, 8%), and 1% (95% CI 0%, 3%), respectively. Lower PW is independently associated with higher probability of PSM in low-risk patients undergoing RARP with bilateral nerve-sparing.

Surgical Margin Status After Robot Assisted Radical Cystectomy: Results From the International Robotic Cystectomy Consortium

Positive surgical margins at radical cystectomy confer a poor prognosis. We evaluated the incidence and predictors of positive surgical margins in patients who underwent robot assisted radical cystectomy for bladder cancer. Using the International Robotic Cystectomy Consortium database we identified 513 patients who underwent robot assisted radical cystectomy, as done by a total of 22 surgeons at 15 institutions from 2003 to 2009. After stratification by age group, gender, pathological T stage, nodal status, sequential case number and institutional volume logistic regression was used to correlate variables with the likelihood of a positive surgical margin. Of the 513 patients 35 (6.8%) had a positive surgical margin. Increasing 10-year age group, lymph node positivity and higher pathological T stage were significantly associated with an increased likelihood of a positive margin (p = 0.010, <0.001 and p <0.001, respectively). Gender, sequential case number and institutional volume were not significantly associated with margin positivity. The rate of margin positive disease at cystectomy was 1.5% for pT2 or less, 8.8% for pT3 and 39% for pT4 disease. Positive surgical margin rates at robot assisted radical cystectomy for advanced bladder cancer were similar to those in open cystectomy series in a large, multi-institutional, prospective cohort. Sequential case number, a surrogate for the learning curve and institutional volume were not significantly associated with positive margins at robot assisted radical cystectomy.

1557 ROLE OF POSITIVE SURGICAL MARGINS IN PATIENTS WITH ORGAN CONFINED PROSTATE CANCER. IMPLICATIONS FOR ADJUVANT TREATMENTS

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 20101557 ROLE OF POSITIVE SURGICAL MARGINS IN PATIENTS WITH ORGAN CONFINED PROSTATE CANCER. IMPLICATIONS FOR ADJUVANT TREATMENTS Alberto Briganti, Nazareno Suardi, Umberto Capitanio, Umberto Capitanio, Andrea Salonia, Andrea Russo, Lorenzo Rocchini, Claudio Doglioni, Cesare Cozzarini, Giorgio Guazzoni, Patrizio Rigatti, and Francesco Montorsi Alberto BrigantiAlberto Briganti More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Andrea RussoAndrea Russo More articles by this author , Lorenzo RocchiniLorenzo Rocchini More articles by this author , Claudio DoglioniClaudio Doglioni More articles by this author , Cesare CozzariniCesare Cozzarini More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Patrizio RigattiPatrizio Rigatti More articles by this author , and Francesco MontorsiFrancesco Montorsi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1322AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent prospective, randomized trials have shown a positive impact of adjuvant radiation therapy (RT) in patients (pts) with Gleason 6-10 and positive surgical margins (SM+). However, despite a trend toward significance even in pts with organ confined (pT2) disease, these studies enrolled only few patients with pT2 SM+. We hypothesized that the outcome of patients with pT2 and SM+ have heterogeneous outcome which differ according to other cancer characteristics. METHODS The study included 1637 ps with node-negative, pT2 disease treated with radical prostatectomy (RP) and pelvic lymph node dissection (PLND) for clinically localized prostate cancer between 1986 and 2007 at a single European tertiary referral center. All pts had complete clinical and pathological data. Pts were divided into 4 groups according to pathological characteristics: pT2 Gleason 6 and negative SM (SM-; group 1; n=861, 52.6%), pT2 Gleason 6 and SM+ (n=123, 7.5%; group 2), pT2 Gleason 7-10 SM- (n=429; 30.1%; group 3), pT2 Gleason 7-10 SM+ (n=161;9.8%; group 4). No pts received any adjuvant treatment after surgery. The Kaplan Meier method assessed the rate of biochemical recurrence (BCR) defined as two consecutive PSA values >0.2 ng/ml. Multivariable Cox regression models tested the association between SM+ and BCR in each category after accounting for pre-op PSA and pathological Gleason sum RESULTS Mean PSA at RP was 7.3 ng/ml (median 6.2 ng/ml; range: 0.4-40 ng/ml). RP Gleason sum was ¡Ü6, 7 and 8-10 in 60.1, 37 and 2.9% pts, respectively. Overall, BCR free survival rates at 2,5 and 8 years were 96,91 and 84%, respectively. Overall, pts with SM+ had significantly lower 2,5 and 8 BCR free survival rates compared to pts with SM- (91, 80 and 76 vs 98,93 and 86% vs respectively; p<0.001). However, when stratified according to Gleason sum, pts with SM+ and Gleason 6 (group 2) had similar 2,5 and 8 year BCR free survival rates as compared to pts with Gleason 6 and SM- (group 1; 95,89 and 89 vs 98,94 and 89%; p=0.2). Conversely, pts with SM+ and high Gleason score (7-10; group 4) had significantly lower 2,5 and 8 year BCR free survival rates as compared to pts with high Gleason but SM- (group 3; 87,71 and 60 vs 96,89 and 76%; p<0.001). At multivariable analyses where presence of SM+ was a significant predictor of BCR only in patients with high Gleason score (HR: 2.6; p=0.01) CONCLUSIONS We demonstrated that SM+ in pT2 disease matters only in presence of high Gleason score. Our results seem to indirectly suggest that, even in presence of SM+, pts with lower Gleason might not be considered candidates for adjuvant treatments Milan, Italy© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e601-e602 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Briganti More articles by this author Nazareno Suardi More articles by this author Umberto Capitanio More articles by this author Umberto Capitanio More articles by this author Andrea Salonia More articles by this author Andrea Russo More articles by this author Lorenzo Rocchini More articles by this author Claudio Doglioni More articles by this author Cesare Cozzarini More articles by this author Giorgio Guazzoni More articles by this author Patrizio Rigatti More articles by this author Francesco Montorsi More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

How Do You Tell Whether a Change in Surgical Technique Leads to a Change in Outcome?

Surgeons routinely evaluate and modify their surgical technique to improve patient outcome. It is also common for surgeons to analyze results before and after a change in technique to determine whether the change led to better results. Simple comparison of results before and after surgical modification may be confounded by the surgical learning curve. We developed a statistical method applicable to analyzing before/after surgical studies. We used simulation studies to compare different statistical analyses of before/after studies. We evaluated a simple 2-group comparison of results before and after the modification by the chi-square test and a novel bootstrap method that adjusts for the surgical learning curve. In the presence of the learning curve a simple 2-group comparison almost always showed an ineffective surgical modification to be of benefit. When the surgical modification was harmful, leading to a 10% decrease in the success rate, 2-group comparison nonetheless showed a statistically significant improvement in outcome about 80% of the time. The bootstrap method had only moderate power but did not show that ineffective surgical modifications were beneficial more than would be expected by chance. Simplistic approaches to the analysis of before/after surgical studies may lead to grossly erroneous results under the surgical learning curve. A straightforward alternative statistical method allows investigators to separate the effects of the learning curve from those of the surgical modification.

The distance of tumor spread in the main pancreatic duct of an intraductal papillary‐mucinous neoplasm: where to resect and how to predict it

The surgical decision regarding where to resect the pancreas is an important judgement that is directly linked to the surgical procedure. An appropriate surgical margin to resect intraductal papillary-mucinous neoplasm (IPMN) of the pancreas based on the distance of tumor spread (DTS) in the main pancreatic duct has not been adequately documented. We analyzed the appropriate surgical margin based on the DTS in the main pancreatic duct of IPMN and the positive rate at the pancreatic cut end margin. Forty patients with main duct- or mixed-type IPMN diagnosed histopathologically who underwent surgery at Tokai University Hospital between 1991 and 2008 were retrospectively analyzed. The resection line was determined to achieve a 2-cm surgical margin in patients with main duct- or mixed-type IPMN and as limited a resection as possible to remove the dilated branch duct in patients with branch duct-type IPMN according to macroscopic type. The dysplastic state of the epithelium was judged as positive for carcinoma in situ (high-grade dysplasia) or adenoma (very low to moderate dysplasia) and judged as negative for hyperplasia or normal. The mean DTS in the main pancreatic duct was 41.6 +/- 30.0 mm, and that of the distance of tumor absence was 13.6 +/- 12.4 mm. The positive rate at the pancreatic cut end margin in frozen sections was 29.7%. The final positive rate at the pancreatic cut end margin was 26.2%. There has been no evidence of local recurrence in the remnant pancreas. DTS in the main pancreatic duct of IPMN was correlated with the maximum diameter of the duct (R = 0.678). Distance of tumor spread offered important insights about the appropriate site to resect the pancreas and the positive rate at the cut end margin in IPMN.

Editorial Comment

The authors present data regarding the limited effect of a positive parenchymal margin during partial nephrectomy on cancer-specific outcomes. Despite the finding of a positive margin in 17 patients (15%), only 2 of 13 sites assessed pathologically by either repeat resection or nephrectomy were found to contain residual cancer. None of these 17 patients experienced a recurrence or death due to renal cancer. These data agree with several other recent publications indicating that positive margins during partial nephrectomy have limited effect on cancer-specific outcomes. 1 Yossepowitch O. Thompson R.H. Leibovich B.C. et al. Positive surgical margins at partial nephrectomy: predictors and oncological outcomes. J Urol. 2008; 179: 2158-2163 Abstract Full Text Full Text PDF PubMed Scopus (232) Google Scholar , 2 Kwon E.O. Carver B.S. Snyder M.E. et al. Impact of positive surgical margins in patients undergoing partial nephrectomy for renal cortical tumours. BJU Int. 2007; 99: 286-289 Crossref PubMed Scopus (113) Google Scholar , 3 Permpongkosol S. Colombo J.R. Gill I.S. et al. Positive surgical parenchymal margin after laparoscopic partial nephrectomy for renal cell carcinoma: oncological outcomes. J Urol. 2006; 176: 2401-2404 Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar Although recent data indicate that enucleation (tumor resection without a margin) provides excellent oncologic outcomes, 4 Carini M. Minervini A. Masieri L. et al. Simple enucleation for the treatment of PT1a renal cell carcinoma: our 20-year experience. Eur Urol. 2006; 50 (discussion: 1269-1271): 1263-1268 Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar we believe that the goal of partial nephrectomy is complete tumor resection with a minimal rim of normal parenchyma. 5 Castilla E.A. Liou L.S. Abrahams N.A. et al. Prognostic importance of resection margin width after nephron-sparing surgery for renal cell carcinoma. Urology. 2002; 60: 993-997 Abstract Full Text Full Text PDF PubMed Scopus (143) Google Scholar We agree with the authors' conclusion that in a majority of cases, a positive margin should not prompt immediate or delayed radical nephrectomy. Positive Surgical Margins With Renal Cell Carcinoma Have a Limited Influence on Long-term Oncological Outcomes of Nephron Sparing SurgeryUrologyVol. 75Issue 2PreviewTo define the rate of positive surgical margins (PSMs) and analyze the outcome of patients with PSMs. The outcome and proper management of patients with positive PSMs during nephron sparing surgery (NSS) are questionable. In this study we define the clinical outcomes of PSMs at NSS and suggest management. Full-Text PDF

Attaining Negative Margins in Breast-Conservation Operations: Is There a Consensus among Breast Surgeons?

The purpose of this survey was to ascertain the most common surgical practices for attaining negative (tumor-free) surgical margins in patients desiring breast-conservation treatment for breast cancer to see if a consensus exists for optimal treatment of patients. We sent a survey to 1,000 surgeons interested in the treatment of breast cancer. Three hundred eighty-one surgeons responded to this survey and 351 were used for the analysis (response rate of 38%). Answers showed a large variety in clinical practices among breast surgeons across the country. There was little intraoperative margin analysis; only 48% of surgeons examine the margins grossly with a pathologist and even fewer used frozen sections or imprint cytology. Decisions to reexcise specific margins varied greatly. For example, 57% of surgeons would never reexcise for a positive deep margin, but 53% would always reexcise for a positive anterior margin. Most importantly, there was a large range in answers about acceptable margins with ductal carcinoma in situ and invasive carcinoma. Fifteen percent of surgeons would accept any negative margin, 28% would accept a 1-mm negative margin, 50% would accept a 2-mm negative margin, 12% would accept a 5-mm negative margin, and 3% would accept a 10-mm negative margin. Results of this survey highlight the wide variety of practice patterns in the US for handling surgical margins in breast-conservation treatment. This issue remains controversial, with no prevailing standard of care. Consequently, additional study is needed in the modern era of multimodality treatment to examine the minimal amount of surgical treatment necessary, in conjunction with chemotherapy and radiation, to attain adequate local control rates in breast-conservation treatment.

Editorial Comment

The authors have confirmed a growing body of evidence showing that positive soft-tissue surgical margins significantly reduces the recurrence-free, disease-specific, and overall survival of patients with invasive bladder cancer after radical cystectomy. A positive margin is a harbinger of local recurrence and eventual death from bladder cancer. Surprisingly, the authors also showed that even patients with positive margins and node-negative disease had better survival if >15 lymph nodes were removed. This suggests that meticulous pelvic lymph node dissection might improve surgical cure of patients with locally advanced bladder cancer. A Thorough Pelvic Lymph Node Dissection in Presence of Positive Margins Associated With Better Clinical Outcomes in Radical Cystectomy PatientsUrologyVol. 74Issue 1PreviewTo evaluate the effect of positive surgical margins in patients with muscle-invasive transitional cell carcinoma of the bladder on survival. Full-Text PDF Editorial CommentUrologyVol. 74Issue 1PreviewThis article is a retrospective survey of radical cystectomy and pelvic lymph node dissection (PLND) for urothelial cancer performed by a single surgeon, at a single institution, during an 18-year period. In the entire cohort of patients, the authors report that positive surgical margins have a decidedly adverse influence on recurrence-free survival, as well as disease-specific and overall survival (OS), an observation already cited in other cystectomy series. This is not surprising in this series, particularly because some of the procedures were performed for palliation rather than cure, ensuring that a number of patients (the authors do not report how many) had advanced disease at surgery. Full-Text PDF

Analysis of p53, c-Myc and c-Erb B2 gene in histopathologically tumour-free surgical margins in patients with oral squamous cell carcinoma

Background and Objectives: In total, 10–30% of patients with oral squamous cell carcinoma (OSCC) develop local recurrences despite seemingly adequate tumour resection. As p53, c-Erb and c-Myc mutations have been considered as selective and sensitive DNA markers of cancer cells, their identification in histopathologically tumour free margins could be of great importance for the recurrence risk evaluation. The aim of this study was to assess the status of p53, c-Myc and c-Erb genes in histologically free tumour margins in patients with OSCC and to correlate with TNM classification, histological grade and patients habits.

A Thorough Pelvic Lymph Node Dissection in Presence of Positive Margins Associated With Better Clinical Outcomes in Radical Cystectomy Patients

To evaluate the effect of positive surgical margins in patients with muscle-invasive transitional cell carcinoma of the bladder on survival. A retrospective evaluation of a prospectively maintained radical cystectomy database consisting of the data from 344 patients was performed. Cox regression analysis was done, and Kaplan-Meier tables were developed to evaluate the contribution of this finding to clinical outcomes. A total of 304 (88.4%) patients had negative surgical margins in the radical cystectomy specimen, and 40 (11.6%) had positive surgical margins. On univariate analysis, positive surgical margins conferred a significant risk of poorer clinical outcomes. The 5-year overall (OS) and disease-specific survival (DSS) rate was 9% and 18% for patients with positive margins compared with 48% and 65% for patients with negative margins, respectively. The multivariate analysis demonstrated a significant independent risk of decreased recurrence-free survival, DSS, and OS for patients with positive surgical margins. The corresponding hazard ratios were 2.29 (95% confidence interval 1.54-3.41, P < .001), 1.71 (95% confidence interval 1.15-2.56, P < .009), and 1.70 (95% confidence interval 1.23-2.34, P < .001). Despite these findings, patients with positive margins and node-negative disease experienced improved DSS and recurrence-free survival (P = .001 P and = .009, respectively) if >15 lymph nodes were removed during surgery. The presence of positive surgical margins in the pathologic specimen confers a significant independent risk of reduced recurrence-free survival, DSS, and overall survival. Nevertheless, patients with positive surgical margins will still benefit from a meticulous pelvic lymph node dissection.

Functional and Oncological Outcomes of Partial Nephrectomy of Solitary Kidneys

We examined outcomes after partial nephrectomy in patients with tumors in a solitary kidney to determine the extent to which patient, surgery and tumor specific variables influenced the glomerular filtration rate and local recurrence postoperatively. Demographics, renal function, comorbidities, renal cell carcinoma history, and operative and pathological data were recorded. The effect on changes in early and late postoperative glomerular filtration rate and local recurrence were analyzed. In 84 patients undergoing a total of 89 partial nephrectomies the mean immediate postoperative decrease in the glomerular filtration rate in those with no ischemia, warm ischemia (mean 12 minutes) and cold ischemia (mean 33 minutes) was 29%, 37% and 45%, respectively (p <0.01). Late glomerular filtration rate decreases were 12%, 6% and 16%, respectively (p = 0.17). Cold ischemia and multiple vascular risk factors were associated with immediate glomerular filtration rate decreases (p = 0.008 and 0.04, respectively). Local recurrence, which developed in 13 patients (18%), was associated with positive margins and T stage (p = 0.01 and 0.02, respectively). End stage renal disease developed in 3 patients (4%) and an additional 5 (6%) required nephrectomy for local recurrence. Partial nephrectomy generally results in a small decrease in the glomerular filtration rate, and limited warm and cold ischemia does not appear to adversely affect long-term renal function. Positive margins and T stage greater than 2 are the most important predictors of local recurrence in a solitary kidney. They pose a significant risk to end stage renal disease-free survival due to the need for completion nephrectomy in many of these patients. Partial nephrectomy should be considered the standard of care in all patients with tumor in the solitary kidney.

Effect of Margin Status on Local Recurrence After Breast Conservation and Radiation Therapy for Ductal Carcinoma In Situ

There is no consensus on what constitutes an adequate surgical margin in patients receiving breast-conserving surgery (BCS) and postoperative radiation therapy (RT) for ductal carcinoma in situ (DCIS). Inadequate margins may result in high local recurrence, and excessively large resections may lead to poor cosmetic outcome without oncologic benefit. A comprehensive search for published trials that examined outcomes after adjuvant RT after BCS for DCIS was performed using MEDLINE and cross referencing available data. Reviews of each study were conducted, and data were extracted. Primary outcome was ipsilateral breast tumor recurrence (IBTR) related to surgical margins. A total of 4,660 patients were identified from trials examining BCS and RT for DCIS. Patients with negative margins were significantly less likely to experience recurrence than patients with positive margins after RT (odds ratio [OR] = 0.36; 95% CI, 0.27 to 0.47). A negative margin significantly reduced the risk of IBTR when compared with a close (OR = 0.59; 95% CI, 0.42 to 0.83) or unknown margin (OR = 0.56; 95% CI, 0.36 to 0.87). When specific margin thresholds were examined, a 2-mm margin was superior to a margin less than 2 mm (OR = 0.53; 95% CI, 0.26 to 0.96); however, we saw no significant difference in the rate of IBTR with margins between 2 mm and more than 5 mm (OR = 1.51; 95% CI, 0.51 to 5.0; P > .05). Surgical margins negative for DCIS should be obtained after BCS for DCIS. A margin threshold of 2 mm seems to be as good as a larger margin when BCS for DCIS is combined with RT.

P3-225: Intraoperative lavage cytology of surgical margins in patients undergoing limited surgery for small lung cancer: Control of postoperative local failure at surgical margins in the pulmonary parenchyma

P3-225: Intraoperative lavage cytology of surgical margins in patients undergoing limited surgery for small lung cancer: Control of postoperative local failure at surgical margins in the pulmonary parenchyma

The effect of margin status on local recurrence following breast conservation and radiation therapy for DCIS

597 Background: There is no consensus on what constitutes an adequate surgical margin in patients receiving breast conserving surgery (BCS) and postoperative irradiation (RT) for ductal carcinoma in situ (DCIS). Inadequate margins may result in high local recurrence, and excessively large resections may lead to poor cosmetic outcome without oncological benefit. Methods: A comprehensive search for published trials which examined outcomes after adjuvant RT following BCS for DCIS was performed using medline and cross referencing available data. Reviews of each study were conducted, and data were extracted. Fixed and random effects methods were used to combine data. Primary outcomes were in breast tumour recurrence (IBTR) related to surgical margins. Results: Analysis of 3,606 patients from randomized trials confirms that patients with negative margins are significantly less likely to recur than those with positive margins after RT (RR 0.53, 95% CI= 0.42 to 0.66, p&lt;0.01). Combined data from randomized and non randomized trials, of 5,500 patients, demonstrates that where the margin status is close or unknown there is significant risk of IBTR compared to a negative margin (RR=1.68, 95% CI= 1.22–2.33, p&lt;0.01). When specific margin thresholds are examined a 2 mm margin is superior to less than 2 mm (OR=0.67, 95% CI 0.51 -0.89, p&lt;0.01), however we saw no significant difference in the rate of IBTR between a 2 mm margin and &gt;5 mm (OR=1.49, 95% CI 0.54 to 4.9, p&gt;0.05). Conclusions: Surgical margins negative for DCIS should be obtained following BCS for DCIS. A margin threshold of 2mm appears be as good as a larger margin when BCS for DCIS is combined with RT. No significant financial relationships to disclose.

Evaluation of Epithelial Dysplasia at the Surgical Margins in Patients with Early Tongue Carcinoma — Immunohistochemical Study of Recurrence of Epithelial Dysplasia

Objective: The diagnosis of epithelial dysplasia at the surgical margins in oral cancer plays an important role in its prognosis and requires careful evaluation. Epithelial dysplasia is usually asymptomatic, but often associated with recurrence and malignant transformation.Patients and Methods: The patients included 9 men and 5 women (mean age, 54.6 years; range, 31 to 76 years) with early tongue carcinoma and tumour-cell-'free " surgical margins. Immunohistochemical analysis of p53 and Ki-67 expression was performed in order to evaluate epithelial dysplasia and pathological changes.Results: None of the patients had cancer recurrence, but 2 showed recurrence of epithelial dysplasia. The resection margins at initial surgery and at recurrence were positive for p53 and Ki-67 in both these patients.Conclusions: Epithelial dysplasia, with positive staining for p53 and Ki-67, has the potential for morphological changes, with possible recurrence of epithelial dysplasia or malignant transformation. Such patients will require careful follow-up for local recurrence. Examination of surgical margins for these markers is useful for the early detection of pathological changes.

Impact of positive surgical margins in patients undergoing partial nephrectomy for renal cortical tumours

To evaluate the clinical outcome of patients undergoing partial nephrectomy (PN) for renal cortical tumours who had a positive surgical margin (SM), as recent studies have shown that a minimal SM is required to achieve equivalent disease-free survival (DFS). Between 1989 and 2005, 777 PNs were performed at the authors' institution. Clinical and pathology data were obtained from our prospective surgical database after obtaining institutional review board approval. Variables were analysed in a logistic regression model to determine predictors of positive SMs. The clinical outcome was reported for local recurrence and distant metastasis and analysed using the log-rank test. Of the 777 PNs, the SM status was documented in 770; the SMs were positive in 57 of 770 (7%). Positive SMs occurred in 33 of 423 (8%) patients with tumours of high malignant potential, and in 24 of 347 (7%) patients with tumours of low malignant potential. On multivariate analysis, an imperative indication for a PN was a significant predictor for a positive SM (P = 0.003). With a median follow-up for survivors of 22 months, there was a local recurrence in two of 57 (4%) patients with a positive SM and four of 713 (0.5%) with a negative SM. No patients with a tumour of low malignant potential had a recurrence, despite having a positive SM. Although local recurrence after PN for renal cortical tumours is rare, our data suggest that patients with a tumour of high malignant potential and a positive SM might have a higher incidence of local recurrence.

Prospective evaluation of p53 as a prognostic marker in T1 transitional cell carcinoma of the bladder

To prospectively evaluate p53 overexpression as a predictor of survival in patients with a first diagnosis of T1 transitional cell carcinoma (TCC) of the bladder, as several reports implicate p53 as an important prognostic marker for progression and survival, but all previous studies were retrospective, giving conflicting and irreproducible results, rendering inappropriate any attempt at integrating p53 into clinical decision-making. Patients with a first diagnosis of T1 TCC of the bladder were enrolled; p53 overexpression was assessed by immunohistochemistry (IHC) using both monoclonal antibody 1801 and DO7. The pathological stage and IHC score were assigned by one pathologist, and the markers were scored categorically. Of the 89 patients who were evaluable, 53 had p53-positive tumours. The median follow-up for the survivors was 52 months. Eighty-two patients had high-grade tumours, using the World Health Organisation/International Society of Urological Pathology 1998 grading system. Fifty-eight patients had unifocal tumours and 34 had associated carcinoma in situ. The 3 year and 5 year overall survival rates were 81% (95% Cl: 73%, 90%) and 68% (95% Cl: 56%, 80%) respectively. The 3 year and 5 year disease specific survival rates were 87% (95% Cl: 79%, 94%) and 79% (95% Cl: 70%, 89%) respectively. There was no difference in disease-specific survival between patients with and without p53 over expression (p=0.56) [corrected] p53 tissue typing by IHC in a prospective cohort of patients with T1 bladder cancer was not clinically useful as a prognostic marker in a contemporary series of T1 tumours.

Laparoscopic Radical Prostatectomy: Impact of Modified Apical and Posterolateral Dissection In Reduction of Positive Surgical Margins in Patients with Clinical Stage T2 Prostate Cancer and High Risk of Extracapsular Extension

To determine whether modifications of extraperitoneal endoscopic radical prostatectomy (EERP) reduce the rate of a positive surgical margin (PSM) in men with clinical stage T(2) prostate cancer and a high risk of extracapsular extension. A consecutive series of 182 men with stage cT(2) tumors and a high risk of extracapsular extension underwent EERP by a single surgeon (VP). The patients were divided into two groups: 71 patients who underwent a standard EERP (group 1) and 111 patients who underwent EERP with the modified technique (group 2). The basic principles of the modified technique are more thorough and wider resection of the posterolateral prostatic pedicles and extensive excision of periprostatic soft tissue at the apex, which results in better mobilization and exposure of the apex before the urethral transection. Differences in PSM rates were analyzed statistically. No significant differences were found between the two groups regarding the clinical and pathologic findings (P > 0.05). The rate of PSM was 28% in group 1 and 10% in group 2 (P < 0.001). Group 2 was less than one third as likely to have PSM as group 2 (odds ratio 2.9; 95% confidence interval 1.6, 3.9). The strongest (P < 0.0001) independent predictors of PSM were the surgical technique, the presence of extracapsular disease, and the volume of the cancer. Preservation of the neurovascular bundles had no impact on margin status (P = 0.93). Functional outcomes and complication rates were not adversely affected by these modifications. The modified dissection in EERP significantly reduces the rate of PSM in patients with stage cT(2) prostate cancer and a high risk of extracapsular extension.

Histopathologic Excision Margin Affects Local Recurrence Rate: Analysis of 2681 Patients With Melanoma ??? 2 mm Thick

Annals of Surgery: April 2006 - Volume 243 - Issue 4 - p 569 doi: 10.1097/01.sla.0000209150.32978.30

1125: Impact of Positive Surgical Margins in Patients Undergoing Partial Nephrectomy for Renal Cortical Tumors

1125: Impact of Positive Surgical Margins in Patients Undergoing Partial Nephrectomy for Renal Cortical Tumors