Authors: A Thind, B Patel, K Thind...

BACKGROUND

Phyllodes tumours represent less than 1% of all UK breast neoplasms. Histological features allow classification into benign, borderline or malignant, which has a significant impact on prognosis and recurrence. Currently, there is no consensus for the optimal surgical excision margin. This systematic review aims to provide a comparative summary of outcomes (local recurrence, metastasis and survival) for borderline and malignant phyllodes tumours resected with either ≥1cm or <1cm margins.

METHODS

MEDLINE and Embase were systematically searched (1990 to July 2019), in line with PRISMA guidelines. Study quality was assessed using the Newcastle-Ottawa scale.

RESULTS

Ten retrospective studies were included (Newcastle-Ottawa scale mean score: 5.6, range: 8-4). Nine reported local recurrence rates, four reported distant metastasis and four reported survival. Meta-analysis pooling demonstrated no statistically significant difference between <1cm and ≥1cm margins in terms of local recurrence rates (relative risk [RR] 1.43, 95% confidence interval [95% CI] 0.70 - 2.93; =0.33, =456), distant metastasis (RR 1.93, 95% CI 0.35 - 10.63; =0.45, =72) or mortality (RR 1.93, 95% CI 0.42 - 8.77; =0.40, =58) for borderline and malignant tumours. Additionally, two studies demonstrated no significant difference in local recurrence for borderline tumours excised with <0.1cm margins compared to ≥1cm.

CONCLUSION

Current evidence suggests that margins <1cm may provide adequate tumour excision. This could enable breast conservation in patients with smaller breast-to-tumour volume ratios, with improved cosmetic outcomes and patient satisfaction. A prospective, multi-institutional trial would be appropriate to further elucidate the safety of smaller margins.

Topics: Breast Neoplasms; Disease-Free Survival; Female; Humans; Margins of Excision; Neoplasm Metastasis; Neoplasm Recurrence, Local; Phyllodes Tumor; Survival Rate

PubMed: 31918563
DOI: 10.1308/rcsann.2019.0140

Review

Authors: Yang Chen, Nian-Nian Zhong, Lei-Ming Cao...

Head and neck squamous cell carcinoma (HNSCC), a prevalent and frequently recurring malignancy, often necessitates surgical intervention. The surgical margin (SM) plays a pivotal role in determining the postoperative treatment strategy and prognostic evaluation of HNSCC. Nonetheless, the process of clinical appraisal and assessment of the SMs remains a complex and indeterminate endeavor, thereby leading to potential difficulties for surgeons in defining the extent of resection. In this regard, we undertake a comprehensive review of the suggested surgical distance in varying circumstances, diverse methods of margin evaluation, and the delicate balance that must be maintained between tissue resection and preservation in head and neck surgical procedures. This review is intended to provide surgeons with pragmatic guidance in selecting the most suitable resection techniques, and in improving patients' quality of life by achieving optimal functional and aesthetic restoration.

Topics: Humans; Margins of Excision; Squamous Cell Carcinoma of Head and Neck; Head and Neck Neoplasms; Quality of Life

PubMed: 38935830
DOI: 10.1097/JS9.0000000000001306

Authors: Ye Beibei, Yang Rong, Yan Yunfei...

BACKGROUND

Laryngeal carcinoma is one of the most common malignant tumors of the head and neck. Researchers have refined the study of surgical margin in the anatomical subarea of the larynx to determine the most appropriate distance of the surgical margin for laryngeal carcinoma, to achieve accurate resection of laryngeal carcinoma and to improve the possibility of retention of laryngeal function.

METHODS

A comprehensive review of the primary literature was performed from 2009 to 2019 utilizing keywords laryngeal carcinoma, surgical margin, molecular margin, and prognostic factor. Articles were included at the discretion of the authors based on novel and/or contributions to the literature.

RESULTS

The prognosis of laryngeal carcinoma significantly correlates with the status of surgical margins. Patients with positive surgical margins have higher recurrence and metastasis rates and worse prognosis. Patients with negative pathological surgical margin but with the expression or altered expression levels of one or more tumor-related molecular biomarkers had high rates of recurrence and metastasis, and poor prognosis.

CONCLUSIONS

Clinical intervention can improve the prognosis of patients with positive surgical margins. Patients with close margins should be followed closely. Among patients with negative surgical margins, patients with abnormal molecular margin results should be closely followed up. However, the specific selection of one or several molecular biomarkers as the detection index of molecular margin currently requires multicenter prospective or retrospective large sample study as guidance.

Topics: Biomarkers, Tumor; Carcinoma; Humans; Laryngeal Neoplasms; Laryngectomy; Margins of Excision; Prognosis

PubMed: 32242752
DOI: 10.1177/0145561320903146

Authors: Jianwei Liu, Guokun Zhuang, Shilei Bai...

OBJECTIVE

The objective of this study was to investigate the impact of surgical margin and hepatic resection on prognosis and compare their importance on prognosis in patients with hepatocellular carcinoma (HCC).

METHODS

The clinical data of 906 patients with HCC who underwent hepatic resection in our hospital from January 2013 to January 2015 were collected retrospectively. All patients were divided into anatomical resection (AR) (n = 234) and nonanatomical resection (NAR) group (n = 672) according to type of hepatic resection. The effects of AR and NAR and wide and narrow margins on overall survival (OS) and time to recurrence (TTR) were analyzed.

RESULTS

In all patients, narrow margin (1.560, 1.278-1.904; 1.387, 1.174-1.639) is an independent risk factor for OS and TTR, and NAR is not. Subgroup analysis showed that narrow margins (2.307, 1.699-3.132; 1.884, 1.439-2.468), and NAR (1.481, 1.047-2.095; 1.372, 1.012-1.860) are independent risk factors for OS and TTR in patients with microvascular invasion (MVI)-positive. Further analysis showed that for patients with MVI-positive HCC, NAR with wide margins was a protective factor for OS and TTR compared to AR with narrow margins (0.618, 0.396-0.965; 0.662, 0.448-0.978). The 1, 3, and 5 years OS and TTR rate of the two group were 81%, 49%, 29% versus 89%, 64%, 49% (P = .008) and 42%, 79%, 89% versus 32%, 58%, 74% (P = .024), respectively.

CONCLUSIONS

For patients with MVI-positive HCC, AR and wide margins were protective factors for prognosis. However, wide margins are more important than AR on prognosis. In the clinical setting, if the wide margins and AR cannot be ensured at the same time, the wide margins should be ensured first.

Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Retrospective Studies; Margins of Excision; Hepatectomy; Neoplasm Invasiveness; Prognosis; Neoplasm Recurrence, Local

PubMed: 37196175
DOI: 10.1093/oncolo/oyad124

Authors: Astrid Herzum, Martina Burlando, Pietro Paolo Tavilla...

BACKGROUND

Basal cell carcinoma (BCC) can cause extensive tissue damage if untreated. Complete surgical excision is the treatment of choice, but especially in the head-and neck area, defining both radical and healthy skin sparing surgical margins is complex.

MATERIALS AND METHODS

Excised, small (≤ 1 cm), BCCs of the head and neck were retrospectively analyzed, comparing histological properness of surgical margins after clinical-dermatoscopical preoperative evaluation (cases), vs. clinical evaluation only (controls) and recurrences.

RESULTS

Of 281 BCCs: 6 % (8/139) of cases and 8 % (12/142) of controls had unproper deep margins; 4 % (5/139) of cases, 20 % (29/142) of controls had unproper lateral margins (P < 0.001). Surgical 3 mm lateral margins were unproper in 0 % (15/66) of cases, 15 % (10/66) of controls (P > 0.005); surgical 1-2 mm lateral margins were unproper in 7 % (5/73) of cases, 25 % (19/76) of controls (P < 0.01). Of cases excised at 3 mm, 1-2 mm, and controls, 1.5 %, 0 %, and 7.7 % recurred, respectively.

CONCLUSIONS

BCC excision at 3 mm may be appropriate in the head and neck for small, dermatoscopically well-defined and non-aggressive BCCs, attaining surgical cure rates of 100 % and 1.5 % recurrences. Excision at 1-2 mm should be reserved only for BCCs in very difficult-to-treat areas, as the surgical cure rate was only 93 %.

Topics: Carcinoma, Basal Cell; Case-Control Studies; Head and Neck Neoplasms; Humans; Margins of Excision; Neoplasm Recurrence, Local; Retrospective Studies; Skin Neoplasms

PubMed: 35581699
DOI: 10.1111/ddg.14757

Authors: Kim E Kortekaas, Koen K Van de Vijver, Mariëtte I E van Poelgeest...

Surgical resection with free surgical margins is the cornerstone of successful primary treatment of vulvar squamous cell carcinoma (VSCC). In general reexcision is recommended when the minimum peripheral surgical margin (MPSM) is <8 mm microscopically. Pathologists are, therefore, required to report the minimum distance from the tumor to the surgical margin. Currently, there are no guidelines on how to make this measurement, as this is often considered straightforward. However, during the 2018 Annual Meeting of the British Association of Gynaecological Pathologists (BAGP), a discussion on this topic revealed a variety of opinions with regard to reporting and method of measuring margin clearance in VSCC specimens. Given the need for uniformity and the lack of guidance in the literature, we initiated an online survey in order to deliver a consensus-based definition of peripheral surgical margins in VSCC resections. The survey included questions and representative diagrams of peripheral margin measurements. In total, 57 pathologists participated in this survey. On the basis of consensus results, we propose to define MPSM in VSCC as the minimum distance from the peripheral edge of the invasive tumor nests toward the inked peripheral surgical margin reported in millimeters. This MPSM measurement should run through tissue and preferably be measured in a straight line. Along with MPSM, other relevant measurements such as depth of invasion or tumor thickness and distance to deep margins should be reported. This manuscript provides guidance to the practicing pathologist in measuring MPSM in VSCC resection specimens, in order to promote uniformity in measuring and reporting.

Topics: Carcinoma, Squamous Cell; Female; Gynecology; Humans; Margins of Excision; Pathologists; Surveys and Questionnaires; Vulvar Neoplasms

PubMed: 31460873
DOI: 10.1097/PGP.0000000000000631

Review

Authors: S Radaelli, P Fossati, S Stacchiotti...

OBJECTIVE

Aim of the manuscript is to discuss how to improve margins in sacral chordoma.

BACKGROUND

Chordoma is a rare neoplasm, arising in half cases from the sacrum, with reported local failure in >50% after surgery.

METHODS

A multidisciplinary meeting of the "Chordoma Global Consensus Group" was held in Milan in 2017, focusing on challenges in defining and achieving optimal margins in chordoma with respect to surgery, definitive particle radiation therapy (RT) and medical therapies. This review aims to report on the outcome of the consensus meeting and to provide a summary of the most recent evidence in this field. Possible new ways forward, including on-going international clinical studies, are discussed.

RESULTS

En-bloc tumor-sacrum resection is the cornerstone of treatment of primary sacral chordoma, aiming to achieve negative microscopic margins. Radical definitive particle therapy seems to offer a similar outcome compared to surgery, although confirmation in comparative trials is lacking; besides there is still a certain degree of technical variability across institutions, corresponding to different fields of treatment and different tumor coverage. To address some of these questions, a prospective, randomized international study comparing surgery versus definitive high-dose RT is ongoing. Available data do not support the routine use of any medical therapy as (neo)adjuvant/cytoreductive treatment.

CONCLUSION

Given the significant influence of margins status on local control in patients with primary localized sacral chordoma, the clear definition of adequate margins and a standard local approach across institutions for both surgery and particle RT is vital for improving the management of these patients.

Topics: Chordoma; Humans; Margins of Excision; Proton Therapy; Radiotherapy Dosage; Sacrum

PubMed: 32402509
DOI: 10.1016/j.ejso.2020.04.028

Authors: Rojin Hasani, Massoumeh Zargaran

BACKGROUND

Incomplete resection is a problem in the management of malignancies. This study is aimed to determine frequency of and risk factors for incomplete surgical margins in skin cancers.

METHODS

In this retrospective study, resected skin cancers of a hospital from 2009 to 2020 were reviewed and, based on histopathology reports, categorized as incomplete/positive or complete/negative margins. The demographics and tumor characteristics were extracted from patients' medical files and compared between two groups.

RESULTS

Three hundred and sixty-four skin cancers were resected from 304 patients; incomplete margins occurred in 26.3%. There were no significant differences in gender, age, and site of tumors on the body parts (including head, neck, trunk, and limbs) between the positive and negative margin groups. Incomplete resections were significantly associated with size, site of tumors on various parts of the head (such as scalp, ear, nose, etc.), number of lesions excised in one session, and physician specialty.

CONCLUSIONS

Size, site of tumors on various parts of the head (such as scalp, ear, nose, etc.), number of lesions excised in one session, and physician specialty are risk factors for positive surgical margin. These characteristics may help clinicians to identify high-risk tumors and reduce the chance of incomplete cancer resection.

Topics: Humans; Margins of Excision; Retrospective Studies; Risk Factors; Scalp; Skin Neoplasms

PubMed: 34013849
DOI: 10.1080/09546634.2021.1927948

Review

Authors: Michaël M E L Henderickx, Suraj V Baldew, Lorenzo Marconi...

PURPOSE

To systematically review the published literature on surgical margins as a risk factor for local recurrence (LR) in patients undergoing partial nephrectomy (PN) for pT1 renal cell carcinomas (RCC).

EVIDENCE ACQUISITION

A systematic literature search of relevant databases (MEDLINE, Embase and the Cochrane Library) was performed according to the PRISMA criteria up to February 2022. The hypothesis was developed using the PPO method (Patients = patients with pT1 RCC undergoing PN, Prognostic factor = positive surgical margins (PSM) detected on final pathology versus negative surgical margins (NSM) and Outcome = LR diagnosed on follow-up imaging). The primary outcome was the rate of PSM and LR. The risk of bias was assessed by the QUIPS tool.

EVIDENCE SYNTHESIS

After assessing 1525 abstracts and 409 full-text articles, eight studies met the inclusion criteria. The percentage of PSM ranged between 0 and 34.3%. In these patients with PSM, LR varied between 0 and 9.1%, whereas only 0-1.5% of LR were found in the NSM-group. The calculated odds ratio (95% confident intervals) varied between 0.04 [0.00-0.79] and 0.27 [0.01-4.76] and was statistically significant in two studies (0.14 [0.02-0.80] and 0.04 [0.00-0.79]). The quality analysis of the included studies resulted in an overall intermediate to high risk of bias and the level of evidence was overall very low. A meta-analysis was considered unsuitable due to the high heterogeneity between the included studies.

CONCLUSION

PSM after PN in patients with pT1 RCC is associated with a higher risk of LR. However, the evidence has significant limitations and caution should be taken with the interpretation of this data.

Topics: Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Margins of Excision; Neoplasm Recurrence, Local; Nephrectomy; Prognosis; Retrospective Studies; Treatment Outcome

PubMed: 35503118
DOI: 10.1007/s00345-022-04016-0

Review

Surgical excision margins for fibrohistiocytic tumors, including atypical fibroxanthoma and undifferentiated pleomorphic sarcoma: A probability model based on a systematic review.

Authors: Atieh Jibbe, Brandon Worley, Corinne H Miller...

BACKGROUND

Mohs micrographic surgery or wide local excision is the treatment of choice for fibrohistiocytic tumors with metastatic potential, including atypical fibroxanthoma (AFX) and cutaneous undifferentiated pleomorphic sarcoma (cUPS). Since margin clearance is the strongest predictor of clinical recurrence, improved recommendations for appropriate surgical margins help delineate uniform excision margins when intraoperative margin assessment is not available.

OBJECTIVE

To determine appropriate surgical wide local excision margins for AFX and cUPS.

METHODS

Literature search (Ovid MEDLINE, Embase, Web of Science, and Cochrane Library from inception to March 2020) to detect case-level data. Estimation of margins required using a mathematical model based on extracted cases without recurrences.

RESULTS

Probabilistic modeling based on 100 cases extracted from 37 studies showed peripheral clearance margin (ie, wide local excision margin) calculated to clear 95% of all tumors was 2 cm for AFX and 3 cm for cUPS. AFX tumors 1 cm or less required a margin of 1 cm.

LIMITATIONS

Data were extracted from published cases.

CONCLUSIONS

Atypical fibroxanthoma removed with at least a 2-cm peripheral excision margin is less likely to recur. Smaller tumors 1 cm or less can be treated with a more conservative margin. Margin-control surgical techniques are recommended to ensure complete removal while minimizing surgical morbidity.

Topics: Histiocytoma, Malignant Fibrous; Humans; Margins of Excision; Mohs Surgery; Neoplasm Recurrence, Local; Probability; Skin Neoplasms

PubMed: 34587553
DOI: 10.1016/j.jaad.2021.09.036