Wide Resection Margins Research Articles

Significance of anatomical resection and wide surgical margin for HCC patients with MVI undergoing laparoscopic hepatectomy: A multicenter study

ObjectiveTo investigate the impact of surgical resection margin and hepatic resection type on prognosis and compare their prognostic significance on patients with hepatocellular carcinoma (HCC) with or without microvascular invasion (MVI) who underwent laparoscopic liver resection (LLR). MethodsA retrospective analysis was conducted on 320 patients with HCC who underwent LLR. According to the grading of MVI, patients were classified as M0, M1 and M2. Patients were divided into the anatomical resection (AR) and nonanatomical resection (NAR) groups according to the hepatic resection type. Survival and Cox regression analyses were performed to explore the effects of AR and NAR, wide and narrow resection margin on overall survival (OS) and time to recurrence (TTR). ResultsIn the whole cohort, narrow resection margin was an independent risk factor for OS and TTR, whereas NAR was not. Subgroup analysis showed that narrow resection margin and NAR were both independent risk factors for OS and TTR in HCC patients with MVI. The 5-year OS and TTR rates of the two groups (NAR-wide resection margin and AR-narrow resection margin) with M1 were 85.3 % versus 62 % and 34.4 % versus 60.2 %. Similarly, the 5-year OS and TTR rates of the two groups (NAR-wide resection margin and AR-narrow resection margin) with M2 were 80.2 % versus 47.9 % and 30.8 % versus 64.8 %. ConclusionsAnatomical hepatectomy and wide resection margin were independent protective factors for HCC patients with MVI receiving LLR. Nonetheless, wide resection margin had a greater impact on prognosis than anatomical hepatectomy.

Bizarre Parosteal Osteochondromatous Proliferation With Malignant Transformation and Metastases.

A patient with a benign bizarre parosteal osteochondromatous proliferation (BPOP) located in the anterior knee was treated with resection in preparation for total knee arthroplasty (TKA). The BPOP reoccurred and was treated with re-resection at the time of TKA. The BPOP reoccurred a second time and underwent malignant transformation to a fungating high-grade pleomorphic sarcoma with metastatic lesions. This case highlights the rare potential of a previously benign BPOP to undergo malignant transformation after recurrence. A wide margin resection may be considered primarily when surgery is indicated to prevent recurrence and its potential sequelae. [Orthopedics. 202x;4x(x):xx-xx.].

Dedifferentiated liposarcoma of the extremities: a Korean multi-center study of 107 cases

BackgroundDedifferentiated liposarcoma of the extremities (DDL-E) is rare in comparison to that of the retroperitoneum. Its clinical features and surgical principle for resection margins at the dedifferentiated and the well-differentiated components are yet to be elucidated.MethodsThis retrospective multi-center study examined patients diagnosed with DDL-E from August 2004 to May 2023 at 5 sarcoma centers. Clinical features, oncologic outcomes, and prognostic factors were analyzed.ResultsA total of 107 patients were reviewed. The 5-year local recurrence free survival (LRFS), metastasis-free survival (MFS) and disease specific survival (DSS) were 84.7%, 78.6%, and 87.8%, respectively. Other primary malignancies and extrapulmonary metastasis were observed in 27 and 4 patients, respectively. The independent risk factor for local recurrence was R1/2 margin at the dedifferentiated component of the tumor. Metastasis was associated with tumor size in univariate analysis. The independent risk factor for DSS was tumor grade. Previous unplanned excision, de novo presentation, tumor depth, absence of the well-differentiated component, infiltrative border, R1/2 margin at the well-differentiated component were not associated with oncologic outcomes.ConclusionsThis is the largest study examining DDL-E to-date. Localized DDL-E has low potential for metastasis and carries an excellent prognosis. Other primary malignancy and extrapulmonary metastasis are more frequent in DDL-E, thus close monitoring of other sites during follow-up is recommended. While wide resection margin is the standard surgical approach for DDL-E, further investigation into moderated wide resection margin at the well-differentiated component is warranted.

Reconstruction of Oncological Defects in the Pelvic-perineal Region: Report on the Consensus Workshop at the 44th Annual Meeting of the DAM 2023 in Bern, CH

The surgical-oncological treatment of pelvic and perineal malignancies is associated with a high complication rate and morbidity for patients. Modern multimodal treatment modalities, such as neoadjuvant radio-chemotherapy for anal or rectal cancer, increase the long-term survival rate while reducing the risk of local recurrence. Simultaneously, the increasing surgical radicality and higher oncological safety with wide resection margins is inevitably associated with larger and, due to radiation, more complex tissue defects in the perineal and sacral parts of the pelvic floor. Therefore, the plastic-surgical reconstruction of complex pelvic-perineal defects following oncological resection remains challenging. The reconstructive armamentarium, and thus the treatment of such defects, is broad and ranges from local, regional and muscle-based flaps to microvascular and perforator-based procedures. While the use of flaps is associated with a significant, well-documented reduction in postoperative complications compared to primary closure, there is still a lack of reliable data directly comparing the postoperative results of different reconstructive approaches. Additionaly, the current data shows that the quality of life of these patients is rarely recorded in a standardised manner. In a consensus workshop at the 44th annual meeting of the German-speaking Association for Microsurgery on the topic of "Reconstruction of oncological defects in the pelvic-perineal area", the current literature was discussed and recommendations for the reconstruction of complex defects in this area were developed. The aim of this workshop was to identify knowledge gaps and establish an expert consensus to ensure and continuously improve the quality of reconstruction in this challenging area. In addition, the importance of the "patient-reported outcome measures" in pelvic reconstruction was highlighted, and the commitment to its widespread use in the era of value-based healthcare was affirmed.

Impact of the Size and Depth of Pulmonary Nodules on the Surgical Approach for Lung Resection in the Treatment of Early-stage Lung Cancer ≤2 cm

Current studies suggest that for early-stage lung cancers with a component of ground-glass opacity measuring ≤2 cm, sublobar resection is suitable if it ensures adequate margins. However, lobectomy may be necessary for some cases to achieve this. The aim of this study was to explore the impact of size and depth on surgical techniques for wedge resection, segmentectomy, and lobectomy in early-stage lung cancer ≤2 cm, and to determine methods for ensuring a safe resection margin during sublobar resections. Clinical data from 385 patients with early-stage lung cancer ≤2 cm, who underwent lung resection in 2022, were subject to a retrospective analysis, covering three types of procedures: wedge resection, segmentectomy and lobectomy. The depth indicator as the OA value, which is the shortest distance from the inner edge of a pulmonary nodule to the opening of the corresponding bronchus, and the AB value, which is the distance from the inner edge of the nodule to the pleura, were measured. For cases undergoing lobectomy and segmentectomy, three-dimensional computed tomography bronchography and angiography (3D-CTBA) was performed to statistically determine the number of subsegments required for segmentectomy. The cutting margin width for wedge resection and segmentectomy was recorded, as well as the specific subsegments and their quantities removed during lung segmentectomy were documented. In wedge resection, segmentectomy, and lobectomy, the sizes of pulmonary nodules were (1.08±0.29) cm, (1.31±0.34) cm and (1.50±0.35) cm, respectively, while the depth of the nodules (OA values) was 6.05 (5.26, 6.85) cm, 4.43 (3.27, 5.43) cm and 3.04 (1.80, 4.18) cm for each procedure, showing a progressive increasing trend (P<0.001). The median resection margin width obtained from segmentectomy was 2.50 (1.50, 3.00) cm, significantly greater than the 1.50 (1.15, 2.00) cm from wedge resection (P<0.001). In wedge resections, cases where AB value >2 cm demonstrated a higher proportion of cases with resection margins less than 2 cm compared to those with margins greater than 2 cm (29.03% vs 12.90%, P=0.019). When utilizing the size of the nodule as the criterion for resection margin, the instances with AB value >2 cm continued to show a higher proportion in the ratio of margin distance to tumor size less than 1 (37.50% vs 17.39%, P=0.009). The median number of subsegments for segmentectomy was three, whereas lobectomy cases requiring segmentectomy involved five subsegments (P<0.001). The selection of the surgical approach for lung resection is influenced by both the size and depth of pulmonary nodules. This study first confirms that larger portions of lung tissue must be removed for nodules that are deeper and larger to achieve a safe margin. A distance of ≤2 cm from the inner edge of the pulmonary nodule to the nearest pleura may be the ideal indication for performing wedge resection.

Internal hemipelvectomy: A single institution's learning curve and longitudinal experience.

Wide margin resection for pelvic tumors via internal hemipelvectomy is among the most technically challenging procedures in orthopedic oncology. As such, surgeon experience and technique invariably affect patient outcomes. The aim of this clinical study was to assess how an individual surgeon's experiences and advancements in technology and techniques in the treatment of internal hemipelvectomy have impacted patient outcomes at our institution. This study retrospectively examined a single tertiary academic institution's consecutive longitudinal experience with internal hemipelvectomy for primary sarcoma or pelvic metastases over a 26-year period between the years 1994 and 2020. Outcomes were assessed using two separate techniques. The first stratified patients into cohorts based on the date of surgery with three distinct "eras" ("early," "middle," and "modern"), which reflect the implementation of new techniques, including three-dimensional (3D) computer navigation and cutting guide technology into our clinical practice. The second method of cohort selection grouped patients based on each surgeon's case experience with internal hemipelvectomy ("inexperienced," "developing," and "experienced"). Primary endpoints included margin status, complication profiles, and long-term oncologic outcomes. Whole group multivariate analysis was used to evaluate variables predicting blood loss, operative time, tumor-free survival, and mortality. A total of 72 patients who underwent internal hemipelvectomy were identified. Of these patients, 24 had surgery between 1994 and 2007 (early), 28 between 2007 and 2015 (middle), and 20 between 2016 and 2020 (modern). Twenty-eight patients had surgery while the surgeon was still inexperienced, 24 while developing, and 20 when experienced. Evaluation by era demonstrated that a greater proportion of patients were indicated for surgery for oligometastatic disease in the modern era (0% vs. 14.3% vs. 35%, p = 0.022). Fewer modern cases utilized freehand resection (100% vs. 75% vs. 55%, p = 0.012), while instead opting for more frequent utilization of computer navigation (0% vs. 25% vs. 20%, p = 0.012), and customized 3D-printed cutting guides (0% vs. 0% vs. 25%, p = 0.002). Similarly, there was a decline in the rate of massive blood loss observed (72.2% vs. 30.8% vs. 35%, p = 0.016), and interdisciplinary collaboration with a general surgeon for pelvic dissection became more common (4.2% vs. 32.1% vs. 85%, p < 0.001). Local recurrence was less prevalent in patients treated in middle and modern eras (50% vs. 15.4% vs. 25%, p = 0.045). When stratifying by case experience, surgeries performed by experienced surgeons were less frequently complicated by massive blood loss (66.7% vs. 40% vs. 20%, p = 0.007) and more often involved a general surgeon for pelvic dissection (17.9% vs. 37.5% vs. 65%, p = 0.004). Whole group multivariate analysis demonstrated that the use of patient-specific instrumentation (PSI) predicted lower intraoperative blood loss (p = 0.040). However, surgeon experience had no significant effect on operative time (p = 0.125), tumor-free survival (p = 0.501), or overall patient survival (p = 0.735). While our institution continues to utilize neoadjuvant and adjuvant therapies following current guideline-based care, we have noticed changing trends from early to modern periods. With the advent of new technologies, we have seen a decline in freehand resections for hemipelvectomy procedures, and a transition to utilizing more 3D navigation and customized 3D cutting guides. Furthermore, we have employed the use of an interdisciplinary team approach more regularly for these complicated cases. Although our results do not demonstrate a significant change in perioperative outcomes over the years, our institution's willingness to treat more complex cases likely obscures the benefits of surgeon experience and recent technological advances for patient outcomes.

Ipsilateral Fibula Grafting in a Case of Aneurysmal Bone Cyst in Tibia Diaphysis: A Case Report

Introduction: Aneurysmal bone cyst (ABC) is a benign, expansile hemorrhagic tumor usually presenting in the metaphyseal region of long bones. Diaphyseal ABCs are rare and prone to pathological fracture and increased morbidity. Treatment options are centered around the site and size of the lesion. Case Report: We report a case of a large ABC in the tibia diaphysis in an 18 year female. The patient was treated with wide margin resection followed by an ipsilateral fibular bone graft of 5 cm, which was followed by good post-operative recovery without any recurrence. At 12-month follow-up, the patient had painless mobility with a full functional range of motion of the affected limb. Conclusion: An early rehabilitation and return to active life can be achieved in diaphyseal ABCs with careful planning and post-operative care. Keywords: Aneurysmal bone cyst, ipsilateral fibula graft, pathological fracture, bone tumor.

Vezani muskulokutani režanj trapeziusa u rekonstrukciji defekta u regiji ramena nakon resekcije mekotkivnog sarkoma - prikaz slučaja i pregled literature

Introduction: Soft tissue sarcomas (STS) in the extremities require complex treatment involving limb-sparing surgery with adjuvant therapy. The treatment involves tumor resection with wide margins along with additional radiation and/ or chemotherapy. In addition to tumor resection, an important aspect is the reconstruction of the resulting soft tissue defect. For extensive reconstructive procedures in the upper extremities, literature suggests the use of free or pedicled flaps. In the shoulder region, due to its complex regional anatomy, selecting an appropriate flap is the surgical imperative. Recently, there has been significant interest in the use of the pedicled trapezius musculocutaneous flap, which offers certain advantages over other flaps. Case report: A female patient (31 years old) with STS in the left shoulder region, was surgically treated three times. The first surgery involved an intralesional procedure - R2 resection when a pleomorphic dermal sarcoma was diagnosed. After five months, a recurrence of the disease was detected based on magnetic resonance imaging (MRI) findings at the site of the surgical scar. Tumor resection was performed, and the soft tissue defect was covered with a free Thiersch partial-thickness skin graft. Histopathological analysis revealed a high-grade leiomyosarcoma. Two months after the second surgery, MRI findings confirmed a recurrence of the disease. Wide tumor resection was conducted, and the soft tissue defect was covered with a pedicled lower trapezius musculocutaneous flap. Conclusion: The literature lacks studies describing the outcomes of the use of trapezius flaps in the reconstruction of defects in the shoulder region following STS resection. Additionally, there is no unanimous official opinion on the resection margin width that is considered safe. The treatment outcome of our patient indicates the significant potential and advantages of the trapezius flap, as compared to other flaps of that region.

Radical resection and reconstruction of a large sternal chondrosarcoma

Introduction. Primary malignant tumors of the sternum are rare, with chondrosarcoma being the most common primary malignant tumor of the chest. The gold standard in treatment is surgical treatment with wide resection margins, where the rigidity of the chest wall must be ensured, with protection of internal organs with satisfactory lung function. Case outline. We present a 67-year-old patient in whom previous computed tomography and magnetic resonance imaging examinations confirmed a tumor mass involving the sternum with the associated ribs, with involvement of the soft tissues above. First, sternum resection was performed with partial resection of the associated ribs and soft tissues. Reconstruction and stabilization of the chest wall were achieved with two layers of polypropylene mesh and methyl methacrylate bone cement with antibiotics. We reconstructed the primary soft tissue defect with a combination of a large local fasciocutaneous flap raised from the abdomen and a smaller sliding flap from the chest. The secondary defect was reconstructed by wide undermining of the skin in the area of the anterior abdominal wall and a small Thiersch-type free skin graft. In the postoperative period, the flaps were vital, but there was necrosis of the free skin graft. That defect was closed secondary thanks to bandaging. Respiratory function was preserved. Conclusion. Surgical treatment is the main treatment for sternal chondrosarcoma. With an adequate preoperative and intraoperative approach, it is necessary to enable good postoperative oncological outcomes with the achievement of chest rigidity and satisfactory respiratory status.

The impact of resection margin width on surgical outcomes for solitary hepatocellular carcinoma with sub-classification of microvascular invasion

The impact of resection margin width on surgical outcomes for solitary hepatocellular carcinoma with sub-classification of microvascular invasion

The impact of resection margin width on surgical outcomes for solitary hepatocellular carcinoma with sub-classification of microvascular invasion

The impact of resection margin width on surgical outcomes for solitary hepatocellular carcinoma with sub-classification of microvascular invasion

Robot-assisted liver resections in locally advanced intrahepatic cholangiocarcinoma

Aim. To evaluate the immediate results of robot-assisted liver resections in locally advanced intrahepatic cholangiocarcinoma.Materials and methods. The research methodology involved the analysis of intraoperative and direct results of robotassisted liver resections from 2015 to June 2023.Results. Total of 89 patients with intrahepatic cholangiocarcinoma underwent surgery. Open liver resection was performed in 59 cases (66.3%), laparoscopic resection – in 22 cases (24.7%), robot-assisted resection – in 8 cases (8.9%). The share of massive liver resections accounted for 83%. The average duration of robot-assisted liver resection amounted to 545 (327–640) minutes, blood loss volume – 300 (100–750) ml, number of resected lymph nodes – 7 (5–11), resection margin width – 6 (5–14) mm. All patients underwent extensive resection with elements of vascular or biliary resection. Severe complications developed only in half of the patients. No deaths or liver failures were reported. The average duration of hospital stay after surgery amounted to 11 (6–15) days.Conclusion. Robot-assisted liver resections expand the indications for minimally invasive surgeries in intrahepatic cholangiocarcinoma due to patients with locally advanced forms. Satisfactory immediate results justify further accumulation and evaluation of the experience of such interventions.

Transoral robotic surgery in oropharyngeal squamous cell carcinoma: A comparative study between da Vinci Single-Port and da Vinci Xi systems

BackgroundThe recently developed da Vinci single-port (SP) system offers potential advantages in maneuverability within narrower surgical spaces. This study aims to compare intra- and post-operative outcomes, technical advantages, and limitations of transoral resections using the da Vinci SP and da Vinci Xi systems for oropharyngeal squamous cell carcinoma (OPSCC). MethodsA single-center retrospective cohort study included patients with OPSCC who underwent transoral robotic surgery (TORS) after neoadjuvant chemotherapy (NCT). Data on pre-operative variables, intraoperative data, postoperative complications, and functional outcomes were collected. ResultsA total of 209 patients (males: 175; mean age: 59.0 ± 9.3) were included (SP: n = 136; Xi: n = 73). A significantly lower docking time was measured for the SP group (5.7 ± 2.5 min vs. 10.0 ± 4.4 min; p <.001). Similarly, the console time was reduced for the SP group though not reaching statistical significance (76.3 ± 30.7 min vs. 88.1 ± 36.9 min; p =.06). A greater proportion of patients showed wide negative resection margins in the SP group (71 % vs. 56 %; p =.10), although not statistically significant. No significant differences were observed in complication rates or postoperative functional outcomes. DiscussionThis study demonstrates the safety and efficacy of the da Vinci SP system in oropharyngeal surgery, with potential advantages in terms of reduced docking and console times. The findings suggest that the SP system offers improved maneuverability and instrument placement compared to the da Vinci Xi system.

Challenges in the Management of Complex Soft-Tissue Sarcoma Clinical Scenarios.

With nearly 15,000 new cases of soft-tissue sarcoma (STS) in the United States each year, early diagnosis and therapeutic management is imperative for successful patient outcomes. Primary STS is conventionally treated with a combination of wide-margin resection, neoadjuvant or adjuvant radiation therapy, and, in specific cases, adjuvant chemotherapy. However, in situations of complex disease presentation, guidelines for treatment are less clearly outlined. Limited metastatic disease, local recurrence, fungating STSs, and unplanned or incomplete resections of STSs present unique challenges for the multidisciplinary care team. The management of complex STS clinical scenarios usually involves limb-salvage resection or amputation as well as some combination of radiation therapy and/or ablative interventional radiology techniques. As a result, a multidisciplinary team approach is essential for treating patients in these challenging scenarios, with a recent focus on the integration of plastic and reconstructive surgery into the treatment algorithm.

A model based on adipose and muscle-related indicators evaluated by CT images for predicting microvascular invasion in HCC patients

Background and aimThe presence of microvascular invasion (MVI) will impair the surgical outcome of hepatocellular carcinoma (HCC). Adipose and muscle tissues have been confirmed to be associated with the prognosis of HCC. We aimed to develop and validate a nomogram based on adipose and muscle related-variables for preoperative prediction of MVI in HCC.MethodsOne hundred fifty-eight HCC patients from institution A (training cohort) and 53 HCC patients from institution B (validation cohort) were included, all of whom underwent preoperative CT scan and curative resection with confirmed pathological diagnoses. Least absolute shrinkage and selection operator (LASSO) logistic regression was applied to data dimensionality reduction and screening. Nomogram was constructed based on the independent variables, and evaluated by external validation, calibration curve, receiver operating characteristic (ROC) curve and decision curve analysis (DCA).ResultsHistopathologically identified MVI was found in 101 of 211 patients (47.9%). The preoperative imaging and clinical variables associated with MVI were visceral adipose tissue (VAT) density, intramuscular adipose tissue index (IMATI), skeletal muscle (SM) area, age, tumor size and cirrhosis. Incorporating these 6 factors, the nomogram achieved good concordance index of 0.79 (95%CI: 0.72–0.86) and 0.75 (95%CI: 0.62–0.89) in training and validation cohorts, respectively. In addition, calibration curve exhibited good consistency between predicted and actual MVI probabilities. ROC curve and DCA of the nomogram showed superior performance than that of models only depended on clinical or imaging variables. Based on the nomogram score, patients were divided into high (> 273.8) and low (< = 273.8) risk of MVI presence groups. For patients with high MVI risk, wide-margin resection or anatomical resection could significantly improve the 2-year recurrence free survival.ConclusionBy combining 6 preoperative independently predictive factors of MVI, a nomogram was constructed. This model provides an optimal preoperative estimation of MVI risk in HCC patients, and may help to stratify high-risk individuals and optimize clinical decision making.

Colorectal cancer hepatic metastases resection margins outcomes: a single-centre retrospective cohort study.

Surgical resection is the most efficient treatment for isolated colorectal cancer hepatic metastases. Among the known prognostic factors of this procedure, the impact of the resection margin width is still a controversial matter in the literature. A retrospective cohort study was performed including 170 patients who underwent surgical resection of colorectal cancer liver metastases (CRLMs) between 2006 and 2016 in our hepatobiliary unit. Resection margin width was determined histologically by measuring the distance from the tumour in millimetres or centimetres. Patients' clinical characteristics were also collected. Patients were then stratified in two tumour margin groups: below 5mm (group A) and equal to or above 5mm (group B). Overall survival (OS) and disease-free survival (DFS) were the primary outcomes. Kaplan-Meier curves showed significantly better outcomes for cases having resection margins above 5mm for both DFS with 1508.7 days (range 1151.2-1866.2) in group A, compared to 2463.9 days (range 2021.3-2906.5) in group B (P=0.049), and OS with 1557.8 days (range 1276.3-1839.3) for group A and 2303.8 days (range 1921.2--2686.4) for group B (P=0.020). This survival benefit was not significant for patients presenting with stage IV CRC at diagnosis or cases where extended (7+ segments) resections were performed. Five-millimetre margins provide a significant survival advantage and should be aimed for in the treatment of CRLMs. Further research on the cause for this finding, including tumour biology's impact on survival, is required.

Reappraisal of an Adequate Negative Margin Following Breast Conservation Therapy in Young Patients with Invasive Breast Cancer

This study aimed to examine the relationship between resection margin (RM) width and ipsilateral breast tumor recurrence (IBTR). The current definition of an adequate negative margin was validated in young breast cancer patients (<40 years). This study included 4,042 patients who underwent breast conservation therapy between 2006 and 2012. There were 595 women <40 years (14.7%). Re-excision to achieve a wider RM was not considered in patients with no ink on tumor. Systemic treatments were administered in 3,985 patients (98.6%). The impact of RM width on the incidence of IBTR was assessed using narrowly specified intervals (positive, >0 to <1 mm, 1 to <2 mm, 2 to <3 mm, and ≥3 mm). A significant relationship was observed between RM width and incidence of IBTR. In young women, the 10-year cumulative incidence rates of IBTR were 21.6% for positive RM, 13.9% for >0 to <1 mm, 10.9% for 1 to <2 mm, 5.7% for 2 to <3 mm, and 5.8% for ≥3 mm (p <0.01). The corresponding incidence rates of IBTR in women ≥40 years were 8.6%, 8.0%, 4.4%, 2.7%, and 2.1%, respectively (p <0.01). The difference in the incidence of IBTR between each RM width interval increased over time, and the magnitude of the increment was greater in young women. RM width was the only risk factor for IBTR in young women. The relationship between RM width and IBTR was definite in young women. Compared with women ≥40 years, young women might have long-term benefits from a wider RM than no ink on tumor.

Intraoperative Ultrasound-Guided Conserving Surgery for Breast Cancer: No More Time for Blind Surgery.

Breast-conserving surgery (BCS) still remains a blind surgery despite all available tumor localization methods. Intraoperative ultrasound (IOUS) allows real-time visualization during all resection phases. This was a prospective observational cohort study conducted at the Veneto Institute of Oncology between January 2021 and June 2022. Patients with ductal carcinoma in situ, T1-2 invasive cancer, or post-neoadjuvant tumors, suitable for BCS, were recruited. All breast cancer lesion types were included, i.e. solid palpable, solid non-palpable, non-solid non-palpable, and post-neoadjuvant treatment residual lesions. Eligible participants were randomly assigned to either IOUS or traditional surgery (TS) in a 1:1 ratio. The main outcomes were surgical margin involvement, reoperation rate, closest margin width, main specimen and cavity shaving margin volumes, excess healthy tissue removal, and calculated resection ratio (CRR). Overall, 160 patients were enrolled: 80 patients were allocated to the TS group and 80 to the IOUS group. IOUS significantly reduced specimen volumes (16.8 cm3 [10.5-28.9] vs. 24.3 cm3 [15.0-41.3]; p=0.015), with wider closest resection margin width (2.0 mm [1.0-4.0] vs. 1.0 mm [0.5-2.0] after TS; p<0.001). Tumor volume to specimen volume ratio was significantly higher after IOUS (4.7% [2.5-9.1] vs. 2.9% [0.8-5.2]; p<0.001). IOUS yielded significantly better CRR (84.5% [46-120.8] vs. 114% [81.8-193.2] after TS; p<0.001), lower involved margin rate (2.5 vs. 15%; p=0.009) and reduced re-excision rate (2.5 vs. 12.5%; p=0.032). IOUS allows real-time resection margin visualization and continuous control during BCS. It showed clear superiority over TS in both oncological and surgical outcomes for all breast cancer lesion types. These results disfavor the paradigm of blind breast surgery.

Resection Margin Width Does Not Influence the Prognosis of Solitary Hepatocellular Carcinoma After Anatomic Resection: A Real-World Study from China.

The influence of resection margin (RM) width on the prognosis of solitary hepatocellular carcinoma (HCC) following anatomical resection (AR) has yet to be determined. Therefore, we conducted a real-world study to identify the optimal RM width and assess its impact on the outcomes of solitary HCC patients undergoing AR. The data pertaining to patients diagnosed with solitary HCC who underwent AR between December 2012 and December 2015 were retrospectively collected. The optimal cutoff value for the width of the RM was determined using X-tile software. The Kaplan-Meier method was utilized to compare the overall survival (OS) and disease-free survival (DFS) between the narrow and wide RM groups. Additionally, propensity score matching (PSM) was performed to minimize potential bias in the data. Of the 1033 patients who met the inclusion criteria, 293 (28.4%) were categorized into the narrow RM group (≤4 mm) and 740 (71.6%) into the wide RM group (> 4mm). Before and after PSM, there were no significant differences in OS and DFS between the two groups (before PSM: OS, HR=0.78, P=0.071; DFS, HR=0.95, P=0.620; after PSM: OS, HR=0.77, P=0.150; DFS, HR=0.90, P=0.470). Multivariate analysis demonstrated that RM width was not an independent risk factor for DFS and OS both before and after PSM (all P>0.05). However, subgroup analyses revealed that patients with ALBI grade 1, absence of cirrhosis, and AJCC stage II significantly benefited from wide RM in OS (all P< 0.05). Similarly, patients without HBV infection and absence of cirrhosis also exhibited significant benefits from wide RM in DFS (both P< 0.05). In patients with solitary HCC undergoing AR, the width of the RM does not appear to have a significant impact on their prognosis. However, in certain selected patients, a wider RM may confer benefits.

Prognostic analysis of postoperative pathological microvascular invasion in hepatocellular carcinoma and the effect of surgical margin on prognosis.

52 Background: To analyze the impact of different MVI grades and surgical margins on patient survival through analyzing the presence of microvascular invasion (MVI) after liver resection of hepatocellular carcinoma (HCC). Methods: The clinical and follow-up data of 513 HCC patients who underwent hepatectomy in our department from January 2016 to December 2020 were analyzed retrospectively. All the patients signed the informed consent form, complying with the medical ethics regulations. Risk factors of MVI in patients with HCC were analyzed by univariate and multivariate analysis, and effect of different MVI grades on postoperative complications was explored. The effects of different MVI grades and different surgical margins on tumor-free survival and overall survival were also analyzed. Results: There were 332 cases in M0 group, 123 cases in M1 group and 58 cases in M2 group. Univariate analysis showed that tumor diameter, tumor number, CNCL stage and alpha-fetoprotein were risk factors for MVI in patients with HCC, and multivariate analysis showed that tumor maximum diameter, tumor number and CNLC stage were independent influencing factors for MVI. There was no significant difference in the incidence of postoperative complications among different groups. The 1-year, 2-year, 3-year disease-free survival rate of M0 group was 79.6%, 71.0%, 63.4%, which was significantly higher than that in M1 group (59.6%, 48.0%，43.3%) and M2 group (31.0%, 27.5%, 25.2%). The 1-year, 2-year, 3-year overall survival rate of M0 group was 97.3%, 88.2%, 84.6%, which was significantly higher than that in M1 group (87.0%, 71.5%, 66.1%), and M2 group (79.3%, 61.9%, 52.6%),respectively. In the aspect of surgical margin, in MVI negative group, the disease-free survival rate of wide margin resection for 1-year, 2-year, 3-year was 82.6%, 70.7%, 65.4%, while that of narrow margin resection was 79.4%, 64.7% and 60.5% (p=0.322).The 1-year, 2-year, 3-year overall survival rate of patients who received wide margin resection was 97.5%, 89.6%, 85.2%, while that of patients who received narrow margin resection was 97.1%, 86.0%，82.8%. (p= 0.822). In the MVI positive group, the 1-year, 2-year and 3-year disease-free survival rate was 58.1%, 45.4%, 40.3% in the wide margin group and 42.9%, 37.3%, 36.1% in the narrow margin group (p=0. 044). The 1-year, 2-year, 3-year overall survival rate of the wide margin group was 88.8%, 71.9%, 64.3%, which was higher than that of the narrow margin group, 82.6%, 64.8%, 61.0% (p = 0.032). Conclusions: Tumor size, number and stage are independent risk factors for MVI positive patients.The higher the MVI grade, the worse the prognosis.In patients with MVI, the long-term prognosis of patients with wide margin is better than that of patients with narrow margin. Therefore, for patients with high risk of MVI before operation, wide margin should be selected as far as possible.