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Surgical Margins

Q: How do different types of surgical procedures impact the required surgical margins?

The required surgical margins can vary depending on the type of surgical procedure and the location of the tumor or lesion. For example, in breast-conserving surgery, a smaller surgical margin may be acceptable, while in more extensive procedures like mastectomy, a larger margin is typically needed. Understanding the nuances of margin requirements for different surgical contexts is crucial for achieving the best possible outcomes.

Q: What are some common challenges in ensuring adequate surgical margins?

One of the key challenges in ensuring adequate surgical margins is accurately determining the extent of the tumor or lesion during the surgical procedure. This can be particularly difficult in cases where the tumor is not clearly visible or has irregular borders. Additionally, the surgeon's skill and experience, as well as the availability of intraoperative imaging or other technologies, can impact their ability to achieve the desired surgical margins.

Q: How can PubCompare.ai help researchers optimize their surgical margins research?

PubCompare.ai's AI-driven platform can assist researchers in streamlining their surgical margins research by providing easy access to relevant protocols from the literature, pre-prints, and patents. The platform's advanced comparisons can help researchers identify the most effective protocols related to surgical margins, enabling them to choose the best option for reproducibility and accuracy. This can enhance the quality and reproducibility of research findings, ultimately advancing the field of surgical oncology.

Q: What specific features of PubCompare.ai can help researchers improve their surgical margins research?

PubCompare.ai allows researchers to more efficiently screen protocol literature and leverage AI to pinpoint critical insights. The platform's AI-driven analysis can highlight key differences in protocol effectiveness, enabling researchers to choose the best option for their specific research goals related to surgical margins. This can help researchers identify the most effective protocols, enhance reproducibility, and improve the quality of their findings.

Surgical Margins: The area of healthy tissue surrounding a removed tumor or lesion.
Ensuring adequate surgical margins is crucial for minimizing the risk of recurrence and optimizing patient outcomes in various surgical procedures.
PubCompare.ai's AI-driven platform can help researchers streamline their surgical margins research by providing easy access to relevant protocols from the literature, pre-prints, and patents, while leveraging advanced comparisons to identify the best practices and products.
This can enhance the reproducibility and quality of research findings, ultimately advancing the field of surgical oncology.

Most cited protocols related to «Surgical Margins»

Prognostic Value of Gleason Grading in Prostate Cancer

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Publication 2015

Aftercare Biopsy Diagnosis Discrimination, Psychology Disease Progression Malignant Neoplasms Needle Biopsies Operative Surgical Procedures Optimism Pathologists Patients Prostatectomy Radiotherapy Recurrence Surgical Margins System, Genitourinary

Assessing Plane of Surgery in Rectal Cancer

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Publication 2009

ARID1A protein, human Blood Vessel Chemoradiotherapy Dissection Ethics Committees, Research Neoplasms Operative Surgical Procedures Pathologists Patients Peritoneum Radiosurgery Surgeons Surgical Margins

Breast Cancer Surgery Timing Analysis

The National Cancer Database^{14 (link)} cohort included those having noninflammatory, invasive, nonmetastatic breast cancer, having surgical treatment as their first modality ≤6 months after their diagnosis date. Patients were included if breast cancer was their first and only malignancy, and if diagnosis and treatment (all or part) was at the reporting facility. Patients without lymph node surgery or whose staging, diagnosis method, or treatment order was unknown were excluded. The NCDB does not provide a diagnosis date, but after 2002 recorded the length of the interval between diagnosis and surgery. This interval length was present for cases diagnosed from 2003 onward. The NCDB requires follow-up of >5 years, so the cohort only included cases from 2003–2005 with follow-up through 2010.
The NCDB contains the most extensive surgery (e.g. a lumpectomy followed by mastectomy lists the patient as having a mastectomy). The NCDB also contains interval lengths from diagnosis to first surgery and from diagnosis to definitive surgery, to determine if the patient underwent >1 procedure. We excluded patients with >1 breast surgery to ensure capture of therapeutic surgery and to eliminate possible confounding excisional biopsies, ensuring that the analysis evaluated the time to therapeutic surgery. Patients receiving neoadjuvant chemotherapy were excluded, and chemotherapy and radiotherapy use were defined as being administered if given ≤1 year after surgery. Missing covariate data is listed in eTable 2.
Adjustments were made for age, sex, race, income, education, size of metropolitan area, geographical region, year of diagnosis, Charlson-Deyo comorbidity score, histology, grade, tumor size, surgical margins, number of nodes examined, number of nodes positive, AJCC stage, surgery type, chemotherapy, radiotherapy, endocrine therapy, facility type, distance to facility, class of case, and insurance type, via propensity score based weighting.

Bleicher R.J., Ruth K., Sigurdson E.R., Beck J.R., Ross E., Wong Y.N., Patel S.A., Boraas M., Chang E.I., Topham N.S, & Egleston B.L. (2016). Time to Surgery and Breast Cancer Survival in the United States. JAMA oncology, 2(3), 330-339.

Publication 2015

Biopsy Diagnosis Lumpectomy Malignant Neoplasm of Breast Malignant Neoplasms Mastectomy Neoadjuvant Chemotherapy Neoplasms Nodes, Lymph Operative Surgical Procedures Patients Pharmacotherapy Radiotherapy Surgical Margins System, Endocrine Therapeutics Thoracic Surgical Procedures

Nomograms for Predicting Survival in Adrenocortical Carcinoma

Categorical variables were reported as whole numbers and proportions, and continuous variables were reported as medians with interquartile ranges (IQRs) unless indicated otherwise. The RFS and OS for the study population were generated using the Kaplan-Meier method, and differences in RFS and OS were examined using the log-rank test. Clinicopathological variables associated with recurrence risk and survival were assessed a priori based on clinical importance, scientific knowledge, and predictors identified in previously published articles.^{9 (link),21 (link),22 (link)} A correlation matrix was used to evaluate all explanatory variables for collinearity, and plausible interaction terms were tested, including interactions between age, sex, tumor size, nodal status, T stage, resection margin, and capsular invasion. No significant interaction was found; therefore, no interaction term was included in the multivariable analysis. Continuous predictors (ie, age and tumor size) were categorized after being assessed using restricted cubic splines to relax the linear relationship assumptions between continuous predictors and recurrence or death risks.^{23 (link)} The risk of recurrence and death was increased based on tumor size (approximately 14 and 12 cm, respectively). To be comparable with previous data,^{24 (link)} tumor size was modeled in the nomograms as a categorical variable (<12 vs ≥12 cm). The associations of relevant clinicopathological variables with RFS and OS were assessed using Cox proportional hazards regression models. Backward stepwise selection with the Akaike information criterion (AIC) was used to identify variables for the multivariable Cox proportional hazards regression models. Hazard ratios (HRs) were presented with their 95% CIs.^{25 (link)} Selected variables were incorporated in the nomograms to predict the probability of 3-year and 5-year RFS and OS rates after curative-intent surgical resection of ACC using statistical software (rms in R, version 3.0.3; http://www.r-project.org).^{26 (link)} For allocating points in the nomograms, the regression coefficients were applied to each individual observation to define the linear predictor.^{27 (link)}The model performance was evaluated by the predictive accuracy for individual outcomes (discriminating ability) and by the accuracy of point estimates of the survival function (calibration). The performance of the nomograms was evaluated using the C statistics by Harrell et al.^{28 (link)} The C statistic estimates the probability of concordance between predicted and observed outcomes in rank order and is equivalent to the area under the receiver operating characteristic curve.^{28 (link)} A C statistic of 0.5 indicates the absence of discrimination, whereas a C statistic of 1.0 indicates perfect separation of patients with different outcomes. Calibration was evaluated using a calibration plot, a graphic representation of the relationship between the observed outcome frequencies and the predicted probabilities, with a bootstrapped sample of the study group. In a well-calibrated model, the predictions should fall on a 45-degree diagonal line. Last, we plotted Kaplan-Meier curves over the tertiles of patients stratified by the scores predicted by the nomograms in the data set to further assess calibration. The model was validated using bootstrapped resampling to quantify any overfitting. Statistical analyses were performed with software programs (Stata, version 14.0; StataCorp LP and R, version 3.0.3; http://www.r-project.org). All tests were 2 sided, and P < .05 was considered statistically significant.

Kim Y., Margonis G.A., Prescott J.D., Tran T.B., Postlewait L.M., Maithel S.K., Wang T.S., Evans D.B., Hatzaras I., Shenoy R., Phay J.E., Keplinger K., Fields R.C., Jin L.X., Weber S.M., Salem A.I., Sicklick J.K., Gad S., Yopp A.C., Mansour J.C., Duh Q.Y., Seiser N., Solorzano C.C., Kiernan C.M., Votanopoulos K.I., Levine E.A., Poultsides G.A, & Pawlik T.M. (2016). Nomograms to Predict Recurrence-Free and Overall Survival After Curative Resection of Adrenocortical Carcinoma. JAMA surgery, 151(4), 365-373.

Publication 2016

Capsule Cuboid Bone Discrimination, Psychology Neoplasms Operative Surgical Procedures Patients Recurrence Surgical Margins

Clinico-pathological Analysis of Oral Squamous Cell Carcinoma

Archives of the Department of Oral Pathology revealed a total of eight hundred and ninety six biopsies diagnosed as Oral squamous cell carcinomas during a two years and nine month period from 2009 to 2011 September. Out of the 896 biopsies, 801 were primary OSCCs, while 95 were recurrent OSCCs.
Data such as the patient’s age, sex, site of the lesion and TNM staging were obtained from the biopsy request forms, while the histopathological diagnosis, status of the excision margins and lymph node involvement were obtained from the biopsy reports. Statistical analysis was performed using the Chi-square test.
Ethical clearance to analyze clinico-pathological information of the oral squamous cell carcinoma patients was obtained from the Dental Faculty, Ethics and review committee of the University of Peradeniya, Sri Lanka. The information was obtained retrospectively from biopsy request forms and oral pathology data base maintained in the department and the identity of each patient is not disclosed in the study. Therefore, according to the existing guidelines, it is not necessary to obtain written or verbal consent from each patient.

Jayasooriya P.R., Pitakotuwage T.N., Mendis B.R, & Lombardi T. (2016). Descriptive study of 896 Oral squamous cell carcinomas from the only University based Oral Pathology Diagnostic Service in Sri Lanka. BMC Oral Health, 16, 1.

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Publication 2016

Biopsy Diagnosis Faculty, Dental Nodes, Lymph Patients Squamous Cell Carcinoma of the Mouth Surgical Margins

Most recents protocols related to «Surgical Margins»

Colorectal Cancer Surgery Outcomes

Patient demographics and perioperative outcomes were obtained from the prospectively collected colorectal cancer database. Patient demographic data included age, sex, preoperative CEA level, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status (PS) classification, and tumor location. Operative outcomes included the total operation time, incision length, blood loss, specimen extraction site, and anastomosis method. Conversion was defined as the transition from laparoscopic to open surgery. Clinical outcomes included postoperative pain management, time to gas pass, sips of water, soft diet, hospital stay, pain score, use of painkillers on postoperative days 1 and 2, postoperative morbidity, and mortality within 30 days. POI was diagnosed when 2 or more of the following 5 criteria were met on or after the 4th postoperative day without resolution of POI: nausea or vomiting, inability to tolerate an oral diet over the previous 24 hours, absence of flatus over the previous 24 hours, abdominal distension, and radiologic confirmation [15 (link)]. Morbidity was classified using the Clavien-Dindo (CD) classification. On postoperative days 1 and 2, postoperative wound pain was measured using a numeric pain rating scale, with endpoints labeled “no pain” (scale 0) and “worst possible pain” (scale 10). Pathological outcomes for colonic adenocarcinoma included tumor stage, histology, retrieved lymph nodes, tumor size, and resection margins. Tumors were classified according to the 8th edition of the American Joint Committee on Cancer (AJCC) cancer staging system.

Kim S., Bae S.U., Jeong W.K., Baek S.K, & Son Y.G. (2023). Effect of intracorporeal anastomosis on postoperative ileus after laparoscopic right colectomy. Annals of Surgical Treatment and Research, 104(3), 156-163.

Publication 2023

Abdomen Analgesics Anesthesiologist BAD protein, human Colon Adenocarcinomas Colorectal Carcinoma Diet Flatulence Hemorrhage Index, Body Mass Joints Nausea Neoplasms Neoplasms by Site Nodes, Lymph Pain, Postoperative Patients Physical Examination Staging, Cancer Surgical Anastomoses Surgical Margins Surgical Procedures, Laparoscopic Wounds

Surgical Techniques for Eyelid Skin Cancer Removal

Anesthesiologists used neuroleptic sedation for each patient with a combination of ketamine, midazolam, fentanyl and propofol. The surgeon used loupes with a 3.3X magnification and a headlight. The tumour was assessed, measured (Figure 1A), and marked with standard four millimetre surgical margins for BCC and seven millimeter surgical margins for melanoma in situ (MIS). The width of the excised area was documented. The donor tissue width was estimated and marked (Figure 1B). The donor lid was then stretched horizontally, ensuring that the secondary defect could undergo direct closure. One drop of topical anesthesia was placed in each eye and the operative site was prepared with controlled use of chlorhexidine to limit the risk of corneal toxicity. The surgeon performed subcutaneous infiltration of the tumor and donor sites using lidocaine 2% with epinephrine 1:100,000; 2 ml or less per eyelid. All tissue was handled with 0.5 mm toothed forceps to preserve its architecture and integrity.

McDonald H.M., McDonald K.A, & McDonald H. (2023). The free bilamellar autograft (FBA) procedure: A comprehensive case series of an alternative surgical approach to reconstruction of large eyelid defects. Frontiers in Surgery, 10, 1038952.

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Publication 2023

Anesthesiologist Antipsychotic Agents Chlorhexidine Cornea Epinephrine Eyelids Fentanyl Forceps Ketamine Lidocaine Melanoma Midazolam Neoplasms Patients Propofol Sedatives Surgeons Surgical Margins Tissue Donors Tissues Topical Anesthetics

Robotic-assisted Hysterectomy vs. Open Hysterectomy

The inclusion criteria were as follows: (1) patients: patients of any sex, age, race or nationality who had undergone robot-assisted laparoscopy and OH. (2) Intervention measures: The experimental group received RAH, and the control group received OH. (3) Outcomes: At least one of the following outcomes is reported: operative time, blood loss, blood transfusion, resection margins, hospital stay, postoperative complications, and recurrence rate. (4) Study design: randomized controlled trial, retrospective cohort study or comparative studies. (5) No language limitations.
The exclusion criteria were as follows: (1) studies with no major outcome indicators in the literature; (2) case reports, abstracts, conference reports or experiments; and (3) studies whose samples had undergone surgery of other organs.

Xuea Q., Wua J., Leia Z., Wanga Q., Fua J, & Gaoa F. (2023). Robot-assisted versus open hepatectomy for liver tumors: Systematic review and meta-analysis. Journal of the Chinese Medical Association, 86(3), 282-288.

Publication 2023

Blood Transfusion Conferences Hemorrhage Laparoscopy Operative Surgical Procedures Patients Postoperative Complications Recurrence Surgical Margins

Cervical Cancer Chemoradiotherapy Outcomes

DFS was defined as the time from the initial diagnosis (histology) to disease recurrence or death from any cause. OS was defined as the time from initial diagnosis (histology) to death from any cause. PC is defined as the absence of local and nodal disease within the pelvis. LC was defined as the absence of disease in postoperative hysterectomy region, upper vagina, and parametria on gynecologic examination at follow-up. Data regarding patients with no evidence of recurrence or death were censored at the date of the last follow-up. Follow-up was defined as the time from the end of treatment to the relevant event (death from any cause, cancer-specific death, any recurrence, local recurrence, and pelvic recurrence).
All toxicity data were scored using the Common Terminology Criteria of Adverse Events (CTCAE) version 4.0.
Gastrointestinal (GI) and genitourinary (GU) radiotherapy-related toxicities were categorized into acute (symptoms experienced during or ≤ 3 months of completion of CRT-S) and chronic (> 3 months after CRT-S).
Surgical morbidity and mortality were evaluated and registered during hospitalization and postoperative (acute, ≤ 6 weeks postoperative) and at every visit thereafter (late). Based on CTCAE v4, the following data were extracted: urinary infection, wound infection, urinary fistula, digestive fistula, ileus, bowel subobstruction, and thromboembolic events.
Pathology results were analyzed with regard to resection margins and pathological response (residual tumor was defined as ≥ 10 mm grossly and < 10 mm microscopically); they were also compared with the imaging performed after CRT.

Van Damme A., Rombaut J., Makar A., De Jaeghere E., Naert E., Denys H., Salihi R., Tummers P, & Vandecasteele K. (2023). Completion surgery after intensity-modulated arc therapy for locally advanced cervical cancer: long-term follow-up and update on surgical outcome and oncologic results of a unique tertiary care single-center retrospective cohort. World Journal of Surgical Oncology, 21, 84.

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Publication 2023

Diagnosis Digestive System Fistula Gynecological Examination Hospitalization Hysterectomy Ileus Intestines Malignant Neoplasms Operative Surgical Procedures Parametrium Patients Pelvis Radiation Sickness Recurrence Residual Tumor Surgical Margins System, Genitourinary Thromboembolism Urinary Fistulas Urinary Tract Infection Vagina Wound Infection

Hyperspectral Imaging for Glioma Biopsy Analysis

We analyzed 240 biopsies obtained from a cohort of 26 patients undergoing surgery for lesions suspicious of HGG (Table 1) using two different imaging devices: the surgical microscope KINEVO 900 and a modified OPMI pico microscope (Fig. 2) for HI. We here evaluate the hyperspectral data using a sample cohort, of which primary data was published in part earlier³⁰.Table 1

Overview of the patient cohort³⁰. Patients and biopsies were classified according to 2016 World Health Organization (WHO) criteria^{43 (link)} (isocitrate dehydrogenase (IDH) mutant or wild type, O⁶-methylguanine-DNA-methyltransferase (MGMT) positive/methylated or negative/not-methylated) and according to the standardized performance score by the Eastern Cooperative Oncology Group (ECOG)^{44 (link)}.

		Patients	%	Biopsies	%
Number		26		240
Gender	Male	17	65	159	66
	Female	9	35	81	34
Age	Mean (SD), Range	60.8 ± 9.5, 37—75
Histology	Anaplastic astrocytoma IDH-mutant, MGMT positive	1	4	10	4
	Glioblastoma IDH-wild type, MGMT positive	13	50	124	52
	Glioblastoma IDH-wild type, MGMT negative	10	38	86	36
	Glioblastoma IDH-mutant, MGMT positive	2	8	20	8
ECOG score	1	16	62	144	60
	2	10	38	96	40
Primary tumor		16	62	150	63
Recurrent tumor		10	38	90	37

A standard dose of 20 mg/kg of 5-ALA (Gliolan®, medac, Wedel, Germany) was orally administered four hours before induction of anesthesia. Biopsies were collected from the non-contrast enhancing, FLAIR positive, infiltrative tumor margins during surgery. Nine biopsies were taken on average per patient (average: 9.2 ± 1.5; range: 5–10 biopsies per patient). The fluorescence quality in the surgical microscope was rated by an experienced neurosurgeon in the categories “none”, “weak”, and “strong” as described previously^{17 (link)}.
Methods were carried out in accordance with relevant guidelines and regulations. All experiments were approved by the local ethics committee of the University of Münster (2020-644-f-S) and informed consent was obtained from all patients.

Walke A., Black D., Valdes P.A., Stummer W., König S, & Suero-Molina E. (2023). Challenges in, and recommendations for, hyperspectral imaging in ex vivo malignant glioma biopsy measurements. Scientific Reports, 13, 3829.

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Publication 2023

Anesthesia Biopsy Debility Isocitrate Dehydrogenase (NAD+) Medical Devices Microscopy Microscopy, Fluorescence Neoplasms Neurosurgeon O(6)-Methylguanine-DNA Methyltransferase Operative Surgical Procedures Patients Regional Ethics Committees Surgical Margins

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What is the importance of ensuring adequate surgical margins?

Ensuring adequate surgical margins is crucial for minimizing the risk of cancer recurrence and optimizing patient outcomes. The surgical margin refers to the area of healthy tissue surrounding the removed tumor or lesion. By removing the tumor with a sufficient margin of healthy tissue, surgeons can help ensure that all cancerous cells have been excised, reducing the likelihood of the cancer returning in the same location.

How do different types of surgical procedures impact the required surgical margins?

The required surgical margins can vary depending on the type of surgical procedure and the location of the tumor or lesion. For example, in breast-conserving surgery, a smaller surgical margin may be acceptable, while in more extensive procedures like mastectomy, a larger margin is typically needed. Understanding the nuances of margin requirements for different surgical contexts is crucial for achieving the best possible outcomes.

What are some common challenges in ensuring adequate surgical margins?

One of the key challenges in ensuring adequate surgical margins is accurately determining the extent of the tumor or lesion during the surgical procedure. This can be particularly difficult in cases where the tumor is not clearly visible or has irregular borders. Additionally, the surgeon's skill and experience, as well as the availability of intraoperative imaging or other technologies, can impact their ability to achieve the desired surgical margins.

How can PubCompare.ai help researchers optimize their surgical margins research?

PubCompare.ai's AI-driven platform can assist researchers in streamlining their surgical margins research by providing easy access to relevant protocols from the literature, pre-prints, and patents. The platform's advanced comparisons can help researchers identify the most effective protocols related to surgical margins, enabling them to choose the best option for reproducibility and accuracy. This can enhance the quality and reproducibility of research findings, ultimately advancing the field of surgical oncology.

What specific features of PubCompare.ai can help researchers improve their surgical margins research?

PubCompare.ai allows researchers to more efficiently screen protocol literature and leverage AI to pinpoint critical insights. The platform's AI-driven analysis can highlight key differences in protocol effectiveness, enabling researchers to choose the best option for their specific research goals related to surgical margins. This can help researchers identify the most effective protocols, enhance reproducibility, and improve the quality of their findings.

More about "Surgical Margins"

Surgical Margins, Resection Margins, Excision Margins, Cancer Surgery, Surgical Oncology, MeSH, PubCompare.ai, SAS version 9.4, SPSS version 25, QIAamp DNA Mini Kit, TRIzol reagent, SPSS version 20, SPSS Statistics version 22