Micrometastasis in surrounding liver and the minimal length of resection margin of primary liver cancer

AIM： To describe the distribution of micrometastases in the surrounding liver of patients with primary liver cancer （PLC）, and to describe the minimal length of resection margin （RM） for hepatectomy. METHODS： From November 2001 to March 2003, 120 histologically verfied PLC patients without macroscopic tumor thrombi or macrosatellites or extrahepatic metastases underwent curative hepatectomy. Six hundreds and twenty-nine routine pathological sections from these patients were re-examined retrospectively by light microscopy. In the prospective study, curative hepatectomy was performed from November 2001 to March 2003 for 76 histologically verfied PLC patients without definite macroscopic tumor thrombi or macrosatellites or extrahepatic metastases in preoperative imaging. Six hundreds and forty-five pathological sections from these patients were examined by light microscopy. The resected liver specimens were minutely examined to measure the resection margin and to detect the number of daughter tumor nodules, dominant lesions, and macroscopic tumor thrombi inside the lumens of the major venous system. The paraffin sections were microscopically examined to detect the microsatellites, microscopic tumor thrombi, fibrosis tumor capsules, as well as capsule invasion and the distance of histological spread of the micrometastases. RESULTS： In the retrospective study, 70 micrometastases were found in surrounding liver in 26 of the 120 cases （21.7%）. The farthest distance of histological micrometastasis was 3.5 mm, 5.3 mm and 6.0 mm in 95%, 99% and 100% cases, respectively. Macroscopic tumor thrornbi or rnacrosatellites were observed in 18 of 76 cases, and 149 rnicrometastases were found in the surrounding live in 25 （43.1%） of 58 cases with no macroscopic tumor thrombi. The farthest distance of histological micrometastasis was 4.5 mm, 5.5 mm and 6.0 mm in 95%, 99% and 100% cases, respectively. Two hundred and sixty-seven rnicrometastases were found in surrounding liver in 14 （77.8%） out of 18 cases with macroscopic tumor thrombi or macrosatellites. The farthest distance of histological micrometastasis was 18.5 mm, 18.5 mm and 19.0 mm in 95%, 99% and 100% cases, respectively. CONCLUSION： The required minimal length of RM is 5.5 mm and 6 mm respectively to achieve 99% and 100% rnicrometastasis clearance in surrounding liver of PLC patients without macroscopic tumor thrornbi or rnacrosatellites, and should be greater than 18.5 mm to obtain 99% rnicrometastasis clearance in surrounding liver of patients with macroscopic tumor thrornbi or rnacrosatellites.

Study of circumferential resection margin in patients with middle and lower rectal carcinoma

AIM: To clarify the relationship between circumferential resection margin status and local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma. The relationship between circumferential resection margin status and clinicopathologic characteristics of middle and lower rectal carcinoma was also evaluated. METHODS: Cancer specimens from 56 patients with middle and lower rectal carcinoma who received total mesorectal excision at the Department of General Surgery of Guangdong Provincial People's Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. RESULTS: Local recurrence occurred in 12.5% (7 of 56 cases) of patients with middle and lower rectal carcinoma. Distant recurrence occurred in 25% (14 of 56 cases) of patients with middle and lower rectal carcinoma. Twelve patients (21.4%) had positive circumferential resection margin. Local recurrence rate of patients with positive circumferential resection margin was 33.3% (4/12), whereas it was 6.8% (3/44) in those with negative circumferential resection margin (P = 0.014). Distant recurrence was observed in 50% (6/12) of patients with positive circumferential resection margin; conversely, it was 18.2% (8/44) in those with negative circumferential resection margin (P = 0.024). Kaplan-Meier survival analysis showed significant improvements in median survival (32.2 ± 4.1 mo, 95% CI: 24.1-40.4mo vs 23.0 ± 3.5 mo, 95% CI: 16.2-29.8 mo) for circumferential resection margin-negative patients over circumferential resection margin-positive patients (log-rank, P < 0.05). 37% T3 tumors examined were positive for circumferential resection margin, while only 0% T1 tumors and 8.7% T2 tumors were examined as circumferential resection margin. The difference between these three groups was statistically significant (P = 0.021). In 18 cancer specimens with tumor diameter ≥ 5 cm 7 (38.9%) were detected as positive circumferential resection margin, while in 38 cancer specimens with a tumor diameter of < 5 cm only 5 (13.2%) were positive for circumferential resection margin (P = 0.028). CONCLUSION: Our findings indicate that circumferential resection margin involvement is significantly associated with depth of tumor invasion and tumor diameter. The circumferential resection margin status is an important predictor of local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma.

Abdominoperineal excision following preoperative radiotherapy for rectal cancer: Unfavorable prognosis even with negative circumferential resection margin

AIM: To evaluate whether an abdominoperineal excision (APE) is associated with increased local recurrence (LR) and shortened disease-free survival (DFS) in mid-low rectal cancer with a negative circumferential resection margin (CRM).

Impact of resection margins on long-term survival after pancreaticoduodenectomy for pancreatic head carcinoma

BACKGROUND The impact of resection margin status on long-term survival after pancreaticoduodenectomy(PD) for patients with pancreatic head carcinoma remains controversial and depends on the method used in the histopathological study of the resected specimens. This study aimed to examine the impact of resection margin status on the long-term overall survival of patients with pancreatic head carcinoma after PD using the tumor node metastasis standard.METHODS Consecutive patients with pancreatic head carcinoma who underwent PD at the Chinese People's Liberation Army General Hospital between May 2010 and May 2016 were included. The impact of resection margin status on long-term survival was retrospectively analyzed.RESULTS Among the 124 patients, R0 resection was achieved in 85 patients(68.5%), R1 resection in 38 patients(30.7%) and R2 resection in 1 patient(0.8%). The 1-and 3-year overall survival(OS) rates were significantly higher for the patients who underwent R0 resection than the rates for those who underwent R1 resection(1-year OS rates: 69.4% vs 53.0%;3-year OS rates: 26.9% vs 11.7%). Multivariate analysis showed that resection margin status and venous invasion were significant risk factors for OS.CONCLUSION Resection margin was an independent risk factor for OS for patients with pancreatic head carcinoma after PD. R0 resection was associated with significantly better OS after surgery.

Distal margin distance in radical resection of locally advanced rectal cancer after neoadjuvant therapy

Colorectal cancer has a high incidence and mortality rate in China, with the majority of cases being middle and low rectal cancer. Surgical intervention is currently the main treatment modality for locally advanced rectal cancer, with the common goal of improving oncological outcomes while preserving function. The controversy regarding the circumferential resection margin distance in rectal cancer surgery has been resolved. With the promotion of neoadjuvant therapy concepts and advancements in technology, treatment strategies have become more diverse.Following tumor downstaging, there is an increasing trend towards extending the safe distance of distal rectal margin. This provides more opportunities for patients with low rectal cancer to preserve their anal function.However, there is currently no consensus on the specific distance of distal resection margin.

One-versus two-stage partial hepatectomy for large resectable solitary hepatocellular carcinomas determined preoperatively to have a narrow resection margin:a propensity score matching analysis

Background:For patients with a large but resectable solitary hepatocellular carcinoma(HCC)of>5 cm in diameter,it is often difficult to achieve a sufficient resection margin.There is still no study on whether a two-stage hepatectomy to increase a narrow resection margin would be beneficial.Methods:From August 2014 to February 2017,patients with a large but resectable solitary HCC of>5 cm and a preoperative estimated resection margin of<1.0 cm were retrospectively studied.They were divided into one-and two-stage resection groups.A retrospective analysis was performed,followed by propensity score matching(PSM)analysis.Disease recurrence,survival,intraoperative and postoperative data were compared.Results:Before PSM,the 1-,2-,3-and 4-year recurrence-free survival rates for the one-and two-stage groups were 44.3%,31.7%,24.3%,19.2%versus 60.6%,45.4%,43.5%,32.3%,respectively(P=0.007).The corresponding OS rates were 61.0%,45.2%,43.8%,38.4%versus 69.6%,62.5%,60.7%,57.3%,respectively(P=0.029).After PSM,the 1-,2-,3-and 4-year recurrence-free survival rates for the one-and two-stage groups were 44.0%,31.5%,27.3%,21.0%versus 60.6%,45.4%,43.5%,32.3%,respectively(P=0.013).The corresponding OS rates were 62.5%,41.1%,41.1%,37.5%versus 69.6%,62.5%,60.7%,57.3%,respectively(P=0.038).Differences in the resection margins between the one-and two-stage groups before[0.3(0-0.5)versus 1.2(0.8-2.2)cm]and after[0.2(0-0.5)versus 1.2(0.8-2.2)cm]PSM were also significant.Conclusions:Two-stage hepatectomy allowed a wider resection margin for patients with a resectable but solitary HCC of>5 cm,and resulted in significantly better long-term survival outcomes after partial hepatectomy.

Improving the quality of gastric cancer surgery:factors associated with positive resection margins for gastrectomy

Purpose:Positive margins after gastrectomy have been associated with poor patient prognosis.This study aimed to identify risk factors associated with margin-positive resections.Methods:The National Cancer Database was queried from 2004 to 2014 for all patients with gastric adenocarcinoma who underwent resection with curative intent and had known margin status.Univariable and multivariable logistic regression analysis was performed to identify variables associated with positive margins.Results:A total of 32,193 patients were identified who met study inclusion criteria,of which 11.8%(3786 patients)had a margin-positive resection.Tumor size>6 cm,T3 or T4 tumors,tumor location in the body of stomach or in multiple regions,signet ring cell histology,presence of lymphovascular invasion,positive lymph node involvement,and lack of neoadjuvant therapy were independently associated with an increased risk of positive margins.Conclusions:Advanced disease characteristics,aggressive tumor pathology,and absence of neoadjuvant therapy were associated with margin-positive resections.

Managing crawling-type gastric adenocarcinoma with endoscopic techniques and postoperative monitoring

Crawling-type gastric adenocarcinoma is a rare subtype of gastric cancer with diagnostic and therapeutic challenges due to its flat,ill-defined lesions.Advanced diagnostic techniques,such as narrow-band imaging and linear endoscopic ultrasonography,improve detection,but endoscopic submucosal dissection poses a risk of incomplete resection.Despite negative resection margins,vigilant postoperative monitoring is crucial due to the potential for recurrence.This letter highlights the importance of refined diagnostic criteria,individualized treatment approaches,and continuous follow-up to optimize management of this unique gastric cancer subtype.

Influence of a microscopic positive proximal margin in the treatment of gastric adenocarcinoma of the cardia

AIM： To investigate the influence of a positive proximal margin in total gastrectorny patients with gastric adenocarcinorna of the cardia. METHODS： Medical records of 191 patients with total gastrectornies for adenocarcinorna of the cardia between 1995 and 2000 were reviewed. The clinicopathologic features associated with a positive margin were determined, and the predictors for survival were analyzed. RESULTS： The incidence of positive proximal margin was 8.4% （16/191）. The positive margins were associated with advanced diseases. The tumor size and the depth of tumor invasion were independent risk factors for a positive margin. The mean survival in the positive margin group was 33.9 mo as compared.with 62.4 mo in the negative group （P 〈 0.001）. However, the difference in survival lost significance in subgroup analysis according to stage. Multivariate analysis identified that a positive margin was not an independent prognostic factor for survival. CONCLUSION： A positive margin is more of an indication of advanced disease in patients with gastric adenocarcinoma of the cardia rather than an independent prognostic factor for survival.

Importance of surgical margin in the outcomes of hepatocholangiocarcinoma

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.

Risk factors for local recurrence of middle and lower rectal carcinoma after curative resection

AIM： To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. METHODS： Specimens of middle and lower rectal carcinoma from 56 patients who received curative resection at the Department of General Surgery of Guangdong Provincial People＇s Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. The relations between clinicopathologic characteristics, mesorectal metastasis and circumferential resection margin status were identified in patients with local recurrence of middle and lower rectal carcinoma. RESULTS： Local recurrence of middle and lower rectal carcinoma after curative resection occurred in 7 of the 56 patients （12.5%）, and was significantly associated with family history （Х^2= 3.929, P = 0.047）, high CEA level （Х^2 = 4.964, P = 0.026）, cancerous perforation （Х^2 = 8.503, P = 0.004）, tumor differentiation （Х^2 = 9.315, P = 0.009） and vessel cancerous emboli （Х^2 = 11.879, P = 0.001）. In contrast, no significant correlation was found between local recurrence of rectal carcinoma and other variables such as age （Х^2 = 0.506, P = 0.477）, gender （Х^2 = 0.102, Z2 = 0.749）, tumor diameter （Х^2 = 0.421, P = 0.516）,tumor infiltration （Х^2 = 5.052, P = 0.168）, depth of tumor invasion （Х^2 = 4.588, P = 0.101）, lymph node metastases （Х^2 = 3.688, P = 0.055） and TNM staging system （Х^2 = 3.765, P = 0.152）. The local recurrence rate of middle and lower rectal carcinoma was 33.3% （4/12） in patients with positive circumferential resection margin and 6.8% （3/44） in those with negative circumferential resection margin. There was a significant difference between the two groups （Х^2 = 6.061, P = 0.014）. Local recurrence of rectal carcinoma occurred in 6 of 36 patients （16.7%） with mesorectal metastasis, and in 1 of 20 patients （5.0%） without mesorectal metastasis. However, there was no significant difference between the two groups （Х^2 = 1.600, P = 0.206）. CONCLUSION： Family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are the significant risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. Local recurrence may be more frequent in patients with mesorectal metastasis than in patients without mesorectal metastasis.

Real-time in vivo distal margin selection using confocal laser endomicroscopy in transanal total mesorectal excision for rectal cancer

BACKGROUND Transanal total mesorectal excision(TaTME)allows patients with ultralow rectal cancer to be treated with sphincter-saving surgery.However,accurate delineation of the distal resection margin(DRM),which is essential to achieve R0 resection for low rectal cancer in TaTME,is technically demanding.AIM To assess the feasibility of optical biopsy using probe-based confocal laser endomicroscopy(pCLE)to select the DRM during TaTME for low rectal cancer.METHODS A total of 43 consecutive patients who were diagnosed with low rectal cancer and scheduled for TaTME were prospectively enrolled from January 2019 to January 2021.pCLE was used to determine the distal edge of the tumor as well as the DRM during surgery.The final pathological report was used as the gold standard.The diagnostic accuracy of pCLE examination was calculated.RESULTS A total of 86 pCLE videos of 43 patients were included in the analyses.The sensitivity,specificity and accuracy of real-time pCLE examination were 90.00%[95%confidence interval(CI):76.34%-97.21%],86.96%(95%CI:73.74%-95.06%)and 88.37%(95%CI:79.65%-94.28%),respectively.The accuracy of blinded pCLE reinterpretation was 86.05%(95%CI:76.89%-92.58%).Furthermore,our results show satisfactory interobserver agreement(κ=0.767,standard error=0.069)for the detection of cancer tissue by pCLE.There were no positive DRMs(≤1 mm)in this study.The median DRM was 7 mm[interquartile range(IQR)=5-10 mm].The median Wexner score was 5(IQR=3-6)at 6 mo after stoma closure.CONCLUSION Real-time in vivo pCLE examination is feasible and safe for selecting the DRM during TaTME for low rectal cancer(clinical trial registration number:NCT04016948).

Impact of tumour rupture risk on the oncological rationale for the surgical treatment choice of gastrointestinal stromal tumours

Tumour rupture of gastrointestinal stromal tumours(GISTs)has been considered to be a remarkable risk factor because of its unfavourable impact on the oncological outcome.Although tumour rupture has not yet been included in the current tumor-node-metastasis classification of GISTs as a prognostic factor,it may change the natural history of a low-risk GIST to a high-risk GIST.Originally,tumour rupture was defined as the spillage or fracture of a tumour into a body cavity,but recently,new definitions have been proposed.These definitions distinguished from the prognostic point of view between the major defects of tumour integrity,which are considered tumour rupture,and the minor defects of tumour integrity,which are not considered tumour rupture.Moreover,it has been demonstrated that the risk of disease recurrence in R1 patients is largely modulated by the presence of tumour rupture.Therefore,after excluding tumour rupture,R1 may not be an unfavourable prognostic factor for GISTs.Additionally,after the standard adjuvant treatment of imatinib for GIST with rupture,a high recurrence rate persists.This review highlights the prognostic value of tumour rupture in GISTs and emphasizes the need to carefully take into account and minimize the risk of tumour rupture when choosing surgical strategies for GISTs.

Gastrointestinal stromal tumors:Thirty years experience of an Institution

AIM:To report our experience of gastrointestinal stromal tumors (GISTs) during the last 29 years. METHODS:Thirty two cases of GIST referred to our Institution from the 1st January 1981 to the 10th June 2010 were reviewed. Metastases,recurrence and survival data were collected in relation to age,history,clinical presentation,location,size,resection margins and cellular features. RESULTS:Mean age was 63.7 years (range,40-90) and incidence was slightly higher in males (56%). R0 resection was performed in 90.7% of cases,R1 in 6.2% (2 cases) and R2 in 3.1% (one case). Using Fletcher's classification 8/32 (25%) had high risk,9/32 (28%) intermediate and 15/32 (47%) low risk tumors. Follow-up varied from 1 mo to 29 years,with a median of 8 years; overall survival was 75% (24/32),disease-free survival was 72% and tumor-related mortality was 9.3%. Three patients with high risk GIST were treated with imatinib mesylate:one developed a recurrence after 36 mo,and 2 are free from disease at 41 mo. CONCLUSION:Surgical treatment remains the gold standard therapy for resectable GISTs. Pathological and biological features of the neoplasm represent the most important factors predicting the prognosis.

Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer

BACKGROUND Laparoscopic assisted total gastrectomy(LaTG)is associated with reduced nutritional status,and the procedure is not easily carried out without extensive expertise.A small remnant stomach after near-total gastrectomy confers no significant nutritional benefits over total gastrectomy.In this study,we developed a modified laparoscopic subtotal gastrectomy procedure,termed laparoscopicassisted tailored subtotal gastrectomy(LaTSG).AIM To evaluate the feasibility and nutritional impact of LaTSG compared to those of LaTG in patients with advanced middle-third gastric cancer(GC).METHODS We retrospectively analyzed surgical and oncological outcomes and postoperative nutritional status in 92 consecutive patients with middle-third GC who underwent radical laparoscopic gastrectomy at Department of Pancreatic Stomach Surgery,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,and Peking Union Medical College between 2013 and 2017.Of these 92 patients,47 underwent LaTSG(LaTSG group),and the remaining underwent LaTG(LaTG group).RESULTS Operation time(210±49.8 min vs 208±50.0 min,P>0.05)and intraoperative blood loss(152.3±166.1 mL vs 188.9±167.8 mL,P>0.05)were similar between the groups.The incidence of postoperative morbidities was lower in the LaTSG group than in the LaTG group(4.2%vs 17.8%,P<0.05).Postoperatively,nutritional indices did not significantly differ,until postoperative 12 mo.Albumin,prealbumin,total protein,hemoglobin levels,and red blood cell counts were significantly higher in the LaTSG group than in the LaTG group(P<0.05).No significant differences in Fe or C-reaction protein levels were found between the two groups.Endoscopic examination demonstrated that reflux oesophagitis was more common in the LaTG group(0%vs 11.1%,P<0.05).Kaplan–Meier analysis showed a significant improvement in the overall survival(OS)and disease free survival(DFS)in the LaTSG group.Multivariate analysis showed that LaTSG was an independent prognostic factor for OS(P=0.048)but not for DFS(P=0.054).Subgroup analysis showed that compared to LaTG,LaTSG improved the survival of patients with stage III cancers,but not for other stages.CONCLUSION For advanced GC involving the middle third stomach,LaTSG can be a good option with reduced morbidity and favorable nutritional status and oncological outcomes.

A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol

BACKGROUND： Laparoscopic pancreaticoduodenectomy（LPD）is a safe procedure. Oncological safety of LPD is still a matter for debate. This study aimed to compare the oncological outcomes,in terms of adequacy of resection and recurrence rate following LPD and open pancreaticoduodenectomy（OPD）.METHODS： Between November 2005 and April 2009, 12LPDs（9 ampullary and 3 distal common bile duct tumors）were performed. A cohort of 12 OPDs were matched for age,gender, body mass index（BMI） and American Society of Anesthesiologists（ASA） score and tumor site.RESULTS： Mean tumor size LPD vs OPD（19.8 vs 19.2 mm,P=0.870）. R0 resection was achieved in 9 LPD vs 8 OPD（P=1.000）. The mean number of metastatic lymph nodes and total number resected for LPD vs OPD were 1.1 vs 2.1（P=0.140）and 20.7 vs 18.5（P=0.534） respectively. Clavien complications grade I/II（5 vs 8）, III/IV（2 vs 6） and pancreatic leak（2 vs 1）were statistically not significant（LPD vs OPD）. The mean high dependency unit（HDU） stay was longer in OPD（3.7 vs 1.4 days,P〈0.001）. There were 2 recurrences each in LPD and OPD（logrank,P=0.983）. Overall mortality for LPD vs OPD was 3 vs 6（log-rank, P=0.283） and recurrence-related mortality was 2 vs 1.There was one death within 30 days in the OPD group secondary to severe sepsis and none in the LPD group.CONCLUSIONS： Compared to open procedure, LPD achieved a similar rate of R0 resection, lymph node harvest and longterm recurrence for tumors less than 2 cm. Though technically challenging, LPD is safe and does not compromise oncological outcome.

Cell-type specificity of β-actin expression and its clinicopathological correlation in gastric adenocarcinoma

AIM: To investigate cell type specific distribution of &#x003b2;-actin expression in gastric adenocarcinoma and its correlation with clinicopathological parameters.

Pathology handling of pancreatoduodenectomy specimens:Approaches and controversies

Pancreatic cancer,with a 5% 5-year survival rate,is the fourth leading cause of cancer death in Western countries.Unfortunately,only 20% of all patients benefit from surgical treatment.The need to prolong survival has prompted pathologists to develop improved protocols to evaluate pancreatic specimens and their surgical margins.Hopefully,the new protocols will provide clinicians with more powerful prognostic indicators and accurate information to guide their therapeutic decisions.Despite the availability of several guidelines for the handling and pathology reporting of duodenopancreatectomy specimens and their continual updating by expert pathologists,there is no consensus on basic issues such as surgical margins or the definition of incomplete excision(R1) of pancreatic ductal adenocarcinoma.This article reviews the problems and controversies that dealing with duodenopancreatectomy specimens pose to pathologists,the various terms used to define resection margins or infiltration,and reports.After reviewing the literature,including previous guidelines and based on our own experience,we present our protocol for the pathology handling of duodenopancreatectomy specimens.

Pathological factors affecting gastric adenocarcinoma survival in a Caribbean population from 2000-2010

AIM: To investigate pathological factors related to long term patient survival post surgical management of gas-tric adenocarcinoma in a Caribbean population.METHODS: This is a retrospective, observational study of all patients treated surgically for gastric adenocarci-noma from January 1st 2000 to December 31 st 2010 at The University Hospital of the West Indies, an urban Jamaican hospital. Pathological reports of all gastrecto-my specimens post gastric cancer resection during the specified interval were accessed. Patients with a final diagnosis other than adenocarcinoma, as well as pa-tients having undergone surgery at an external institu-tion were excluded. The clinical records of the selected cohort were reviewed. The following variables were analysed; patient gender, patient age, the number of gastrectomies previous performed by the lead surgeon, the gross anatomical location and appearance of the tumour, the histological appearance of the tumour, infil-tration of the tumour into stomach wall and surround-ing structures, presence of Helicobacter pylori and the presence of gastritis. Patient status as dead vs alive was documented for the end of the interval. The effect of the aforementioned factors on patient survival were analysed using Logrank tests, Cox regression models, Ranksum tests, Kruskal-Wallis tests and Kaplan-Meier curves.RESULTS: A total of 79 patients, 36 males and 43 fe-males, were included. Their median age was 67 years(range 36-86 years). Median survival time from surgery was 70 mo with 40.5% of patients dying before the termination date of the study. Tumours ranged from 0.8 cm in size to encompassing the entire stomach speci-men, with a median tumour size of 6 cm. The median number of nodes removed at surgery was 8 with a maximum of 28. The median number of positive lymph nodes found was 2, with a range of 0 to 22. Patients' median survival time was approximately 70 mo, with 40.5% of the patients in this cohort dying before the terminal date. An increase in the incidence of cardiac tumours was noted compared to the previous 10 year interval(7.9% to 9.1%). Patients who had serosal involvement of the tumour did have a significantly shorter survival than those who did not(P = 0.017). A significant increase in the hazard ratio(HR), 2.424, for patients with circumferential tumours was found(P = 0.044). Via Kaplan-Meier estimates, the presence of venous infiltration as well as involvement of the circum-ferential resection margin were found to be poor prog-nostic markers, decreasing survival at 50 mo by 46.2% and 36.3% respectively. The increased HR for venous infiltration, 2.424, trended toward significant(P = 0.055) Age, size of tumour, number of positive nodes found and total number of lymph nodes removed were not useful predictors of survival. It is noted that the results were mostly negative, that is many tumour character-istics did not indicate any evidence of affecting patient survival. The current sample, with 30 observed events(deaths), would have about 30% power to detect a HR of 2.5.CONCLUSION: This study mirrors pathological factors used for gastric cancer prognostication in other popu-lations. As evaluation continues, a larger cohort will strengthen the significance of observed trends.

Clinicopathological study of surgical margins in squamous cell carcinoma of buccal mucosa

Objective:To evaluate the margins of resected specimen of oral squamous cell car-cinoma (SCC) and to document the surgical margin (measured at the time of resection) and margins at the time of pathological examination (after immersion of the specimen in formalin). Methods:Patients who were diagnosed and confirmed with squamous carcinoma of buccal mu-cosa were included in the study. Patients underwent resection of the tumor with a margin of 1 cm. Soon after resection, the distance between outermost visible margin of the tumor and the margin of the specimen was measured and documented. Specimens were fixed in 10%formalin and submitted for gross and histopathological examination. The closest histopatho-logic margin was compared with the in situ margin (10 mm) to determine and document any shrinkage of the margin and the percentage of discrepancy if any. Results: A total of 52 specimens were collected from patients between January 2014 and December 2014. All specimens were obtained from the oral cavity (n Z 52) of which 43 (82.7%) were squamous cell carcinoma and 9 (17.3%) were verrucous variant of squamous cell carcinoma. The average decrease in tumor margins measured after fixation in formalin wasfound to be statistically significant (P<0.05) in 65%of cases. Conclusion:Tumor margin shrinks significantly after formalin fixation by about 25%. The oper-ating surgeon and pathologist should be well aware of such changes while planning for further management thereby ensuring adequate margin of resection and adjuvant treatment wherever required to prevent possible local recurrence of the disease. Copyright a 2016 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).