Background Invasive cancer of the cervix is considered a preventable disease because it has a long pre-invasive state, cervical cytology screening programs are currently available, and treatment of pre-invasive lesion...Background Invasive cancer of the cervix is considered a preventable disease because it has a long pre-invasive state, cervical cytology screening programs are currently available, and treatment of pre-invasive lesions is effective. We tested the accuracy of frozen section examination （FSE） of cone specimens to identify the endocervical margin and rule out invasion in patients with high-grade cervical intraepithelial neoplasia （CIN）. Methods For 320 consecutive patients with a preoperative biopsy result of CIN stage 2/3, cold-knife conization （CKC） was performed followed by FSE. The results from analyses of permanent paraffin sections （PS） were compared with the FSE findings. Results The accuracy of FSE was 87% （278/320）. For all of the seven patients with an invasive squamous cell carcinoma of the cervix identified by FSE, the diagnosis was confirmed by PS analysis. For one patient, the FSE result was cervicitis, whereas PS ananlysis showed microinvasive carcinoma. Appropriate surgery was performed for all patients based on the FSE and biopsy results. The FSE and PS results were not significantly different （P=-0.000）. Definitive examination of margin status using PS was concordant with FSE findings in all cases. Conclusions FSE is a rapid and reliable method for evaluating CKC specimens. It can identify frank invasion, permit adequate treatment in a one-stage procedure, and reliably detect clear resection margins. Since discrepancies do exist and may result in inappropriate treatment, further research is required to decrease these discrepancies and avoid missing even one case.展开更多
Because of the intramural spread of gastric cancer,a sufficient length of a resection margin has to be attained to ensure complete excision of the tumor.There has been debate on an adequate length of proximal resectio...Because of the intramural spread of gastric cancer,a sufficient length of a resection margin has to be attained to ensure complete excision of the tumor.There has been debate on an adequate length of proximal resection margin(PRM) and its related issues.Thus,the objective of this article is to review several studies on PRM and to summarize the current evidence on the subject.Although there is some discrepancy in the recommended values for PRM between authors,a PRM of more than 2-3 cm for early gastric cancer and 5-6 cm for advanced gastric cancer is thought to be acceptable.Once the margin is confirmed to be clear,however,the length of PRM measured in postoperative pathologic examination does not affect the patient's survival,even when it is shorter than the recommended values.Hence,the recommendations for PRM length should be applied only to intraoperative decision-making to prevent positive margins on the final pathology.Given that a negative resection margin is the ultimate goal of determining an adequate PRM,development and improvement of reliable methods to confirm a negative resection margin intraoperatively would minimize the extent of surgery and offer a better quality of life to more patients.In the same context,special attention has to be paid to patients who have advanced stage or diffuse-type gastric cancer,because they are more likely to have a positive margin.Therefore,a wider excision with intraoperative frozen section(IFS) examination of the resection margin is necessary.Despite all the attempts to avoid positive margins,there is still a certain rate of positive-margin cases.Since the negative impact of a positive margin on prognosis is mostly obvious in low N stage patients,aggressive further management,such as extensive re-operation,is required for these patients.In conclusion,every possible preoperative and intraoperative evaluation should be thoroughly carried out to identify in advance the patients with a high risk of having positive margins;these patients need careful management with a wider展开更多
AIM To evaluate the significance of resection margin width in the management of hepatocholangiocarcinoma(HCC-CC).METHODS Data of consecutive patients who underwent hepatectomy for hepatic malignancies in the period fr...AIM To evaluate the significance of resection margin width in the management of hepatocholangiocarcinoma(HCC-CC).METHODS Data of consecutive patients who underwent hepatectomy for hepatic malignancies in the period from1995 to 2014 were reviewed.Patients with pathologically confirmed HCC-CC were included for analysis.Demographic,biochemical,operative and pathological data were analyzed against survival outcomes. RESULTSForty-two patients were included for analysis.The median age was 53.5 years.There were 29 males.Hepatitis B virus was identified in 73.8%of the patients.Most patients had preserved liver function.The median preoperative indocyanine green retention rate at 15 min was 10.2%.The median tumor size was 6.5 cm.Major hepatectomy was required in over 70%of the patients.Hepaticojejunostomy was performed in 6 patients.No hospital death occurred.The median hospital stay was 13 d.The median follow-up period was 32 mo.The 5-year disease-free survival and overall survival were 23.6%and 35.4%respectively.Multifocality was the only independent factor associated with diseasefree survival[P<0.001,odds ratio 4,95%confidence interval(CI):1.9-8.0].In patients with multifocal tumor(n=20),resection margin of≥1 cm was associated with improved 1-year disease-free survival(40%vs 0%;log-rank,P=0.012).CONCLUSIONHCC-CC is a rare disease with poor prognosis.Resection margin of 1 cm or above was associated with improved survival outcome in patients with multifocal HCC-CC.展开更多
Colorectal cancer includes cancerous growths in the colon, rectum and appendix. With 655000 deaths worldwide per year, it is the third most common form of cancer and the second leading cause of cancer-related death in...Colorectal cancer includes cancerous growths in the colon, rectum and appendix. With 655000 deaths worldwide per year, it is the third most common form of cancer and the second leading cause of cancer-related death in the Western world. Advances in imaging, genetics, molecular diagnostics, surgical techniques and chemotherapy are now making significant gains in our ability to prevent, diagnose, and treat this serious disease. This article reviews some of these recent successes and shares a vision of future care based on current research.展开更多
文摘Background Invasive cancer of the cervix is considered a preventable disease because it has a long pre-invasive state, cervical cytology screening programs are currently available, and treatment of pre-invasive lesions is effective. We tested the accuracy of frozen section examination （FSE） of cone specimens to identify the endocervical margin and rule out invasion in patients with high-grade cervical intraepithelial neoplasia （CIN）. Methods For 320 consecutive patients with a preoperative biopsy result of CIN stage 2/3, cold-knife conization （CKC） was performed followed by FSE. The results from analyses of permanent paraffin sections （PS） were compared with the FSE findings. Results The accuracy of FSE was 87% （278/320）. For all of the seven patients with an invasive squamous cell carcinoma of the cervix identified by FSE, the diagnosis was confirmed by PS analysis. For one patient, the FSE result was cervicitis, whereas PS ananlysis showed microinvasive carcinoma. Appropriate surgery was performed for all patients based on the FSE and biopsy results. The FSE and PS results were not significantly different （P=-0.000）. Definitive examination of margin status using PS was concordant with FSE findings in all cases. Conclusions FSE is a rapid and reliable method for evaluating CKC specimens. It can identify frank invasion, permit adequate treatment in a one-stage procedure, and reliably detect clear resection margins. Since discrepancies do exist and may result in inappropriate treatment, further research is required to decrease these discrepancies and avoid missing even one case.
基金Supported by National Research Foundation of Korea Grant funded by the Korean Government,No. 2010-0024825
文摘Because of the intramural spread of gastric cancer,a sufficient length of a resection margin has to be attained to ensure complete excision of the tumor.There has been debate on an adequate length of proximal resection margin(PRM) and its related issues.Thus,the objective of this article is to review several studies on PRM and to summarize the current evidence on the subject.Although there is some discrepancy in the recommended values for PRM between authors,a PRM of more than 2-3 cm for early gastric cancer and 5-6 cm for advanced gastric cancer is thought to be acceptable.Once the margin is confirmed to be clear,however,the length of PRM measured in postoperative pathologic examination does not affect the patient's survival,even when it is shorter than the recommended values.Hence,the recommendations for PRM length should be applied only to intraoperative decision-making to prevent positive margins on the final pathology.Given that a negative resection margin is the ultimate goal of determining an adequate PRM,development and improvement of reliable methods to confirm a negative resection margin intraoperatively would minimize the extent of surgery and offer a better quality of life to more patients.In the same context,special attention has to be paid to patients who have advanced stage or diffuse-type gastric cancer,because they are more likely to have a positive margin.Therefore,a wider excision with intraoperative frozen section(IFS) examination of the resection margin is necessary.Despite all the attempts to avoid positive margins,there is still a certain rate of positive-margin cases.Since the negative impact of a positive margin on prognosis is mostly obvious in low N stage patients,aggressive further management,such as extensive re-operation,is required for these patients.In conclusion,every possible preoperative and intraoperative evaluation should be thoroughly carried out to identify in advance the patients with a high risk of having positive margins;these patients need careful management with a wider
文摘AIM To evaluate the significance of resection margin width in the management of hepatocholangiocarcinoma(HCC-CC).METHODS Data of consecutive patients who underwent hepatectomy for hepatic malignancies in the period from1995 to 2014 were reviewed.Patients with pathologically confirmed HCC-CC were included for analysis.Demographic,biochemical,operative and pathological data were analyzed against survival outcomes. RESULTSForty-two patients were included for analysis.The median age was 53.5 years.There were 29 males.Hepatitis B virus was identified in 73.8%of the patients.Most patients had preserved liver function.The median preoperative indocyanine green retention rate at 15 min was 10.2%.The median tumor size was 6.5 cm.Major hepatectomy was required in over 70%of the patients.Hepaticojejunostomy was performed in 6 patients.No hospital death occurred.The median hospital stay was 13 d.The median follow-up period was 32 mo.The 5-year disease-free survival and overall survival were 23.6%and 35.4%respectively.Multifocality was the only independent factor associated with diseasefree survival[P<0.001,odds ratio 4,95%confidence interval(CI):1.9-8.0].In patients with multifocal tumor(n=20),resection margin of≥1 cm was associated with improved 1-year disease-free survival(40%vs 0%;log-rank,P=0.012).CONCLUSIONHCC-CC is a rare disease with poor prognosis.Resection margin of 1 cm or above was associated with improved survival outcome in patients with multifocal HCC-CC.
文摘Colorectal cancer includes cancerous growths in the colon, rectum and appendix. With 655000 deaths worldwide per year, it is the third most common form of cancer and the second leading cause of cancer-related death in the Western world. Advances in imaging, genetics, molecular diagnostics, surgical techniques and chemotherapy are now making significant gains in our ability to prevent, diagnose, and treat this serious disease. This article reviews some of these recent successes and shares a vision of future care based on current research.
