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Resection Margin Involvement (resection + margin_involvement)
Selected AbstractsPrognostic value of p27kip1 expression in adenocarcinoma of the pancreatic head regionHPB, Issue 3 2006Jerzy Mielko Abstract Background. p27kip1 is a tumour suppressor gene, functioning as a cyclin-dependent kinase inhibitor, and an independent prognostic factor in breast, colon, and prostate adenocarcinomas. Conflicting data are reported for adenocarcinoma of the pancreas. The aim of this study was to establish the prognostic value of p27kip1 expression in adenocarcinoma of the pancreatic head region. Patients and methods. The study included 45 patients (male/female ratio 2:1; mean age 59, range 38,82 years) with adenocarcinomas of the pancreatic head region: 24 , pancreatic head, 18 , periampullary and 3 , uncinate process. The patients underwent the Kausch-Whipple pancreatoduodenectomy (n=39), pylorus-preserving pancreatoduodenectomy (n=5), or nearly total pancreatectomy (n=1). Eight patients received adjuvant chemotherapy postoperatively. Follow-up time ranged from 3 to 60 months. Tumours were staged according to the pTNM classification (UICC 1997). Immunohistochemistry was done on paraffin-embedded blocks from tumour sections. Quantitative determination of p27kip1 expression was based on the proportion of p27kip1 -positive cells (< 5%= negative). Survival analysis was carried out using the Kaplan-Meier method and Cox regression model. Results. Positive p27kip1 expression was detected in 22 tumours (49%), whereas 23 tumours (51%) were p27kip1 -negative. There were no significant correlations between p27kip1 index and stage or lymph node involvement. Median survival time in patients with p27kip1 -positive tumours was 19 months, whereas in patients with p27kip1 -negative tumours it was 18 months (p=0.53). A significant relationship was found between p27kip1 -negative tumours and radical resection (p=0.04). Multivariate survival analysis revealed that the localization of the tumour (pancreatic head/uncinate process vs periampullary) was the only significant and independent prognosticator (p=0.01, Cox regression model). Resection margins involvement and grade remained nearly significant prognostic factors (p=0.07 and p=0.09, respectively). Conclusion. We conclude that p27kip1 has limited overall prognostic utility in resected carcinoma of the pancreatic head region, but its potential role as a marker of residual disease needs to be further assessed. [source] Tumor budding as a useful prognostic marker in esophageal squamous cell carcinomaDISEASES OF THE ESOPHAGUS, Issue 4 2004M. S. Roh SUMMARY, We examined the prognostic significance of tumor budding in patients with esophageal squamous cell carcinoma, particularly in comparison to other routine pathological findings. Fifty-six cases who underwent an esophagectomy were reviewed. We defined tumor budding as an isolated single cancer cell or a cluster composed of fewer than five cancer cells and divided these into two grades; low-grade (< 5 budding foci) and high-grade (, 5 budding foci) within a microscopic field of ×200. There were 22 (39.3%) and 34 (60.7%) cases with low- and high-grade budding, respectively. There were significant differences in the patients with low- and high-grade budding in relation to tumor size, pT stage, lymphovascular invasion, perineural invasion, circumferential resection margin involvement, and AJCC stage (P < 0.05). The 3-year survival rates of the patients with low- and high-grade budding were 72.3% and 30.7%, respectively (P = 0.04). We propose that tumor budding may be a pathological marker suggesting high malignancy potential and decreased postoperative survival in patients with esophageal squamous cell carcinoma. [source] Hospital volume does not influence long-term survival of patients undergoing surgery for oesophageal or gastric cancerBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2007A. M. Thompson Background: Guidelines suggest that surgery for oesophageal and gastric cancer should be conducted in large cancer centres. This national study examined the relationship between hospital volume and outcome in Scotland. Methods: This was a prospective, population-based study of 3293 consecutive patients with oesophageal or gastric cancer diagnosed between 1997 and 1999. Some 1302 patients underwent surgery and were followed for 5 years after operation. Results: The 5-year adjusted overall survival rate for the 3293 patients was 18·7 (95 per cent confidence interval (c.i.) 17·2 to 20·2) per cent and that after surgical resection was 39·6 (95 per cent c.i. 36·3 to 43·0) per cent. Death within 1 year after surgical resection was associated with a postoperative complication (odds ratio (OR) 2·5 (95 per cent c.i. 1·6 to 3·8); P < 0·001) or resection margin involvement by tumour (OR 7·2 (95 per cent c.i. 1·1 to 47·5); P = 0·042) after adjustment for age, sex and tumour location. There was no relationship between hospital volume and postoperative morbidity or mortality, nor between survival and volume of patients either for hospital of diagnosis or hospital of surgery. Conclusion: This population-based study of oesophageal and gastric cancer suggests that the link between hospital volume and long-term survival for patients undergoing surgery requires re-evaluation. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Pathological determinants of survival in node-negative oesophageal cancer,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2004O. A. Khan Background: Many studies have analysed prognostic factors following oesophagectomy, but few have examined survival determinants in node-negative (N0) oesophageal cancer. The prognostic significance of a number of histological variables following surgical resection of N0 oesophageal cancer was studied. Methods: The case notes of 219 patients undergoing potentially curative oesophagectomy for N0 squamous cell carcinoma or adenocarcinoma of the oesophagus were reviewed. Details of the patient's sex, age at operation, histological type, longitudinal tumour length, tumour (T) stage, circumferential resection margin involvement, tumour grade, presence of vascular invasion, perineural invasion, Barrett's metaplasia, and survival were noted. Univariate and multivariate analyses were performed to identify prognostic factors. Results: Univariate analysis revealed three factors that correlated with poor prognosis: T stage (P = 0·024), adenocarcinoma (P = 0·033) and degree of differentiation (P = 0·001). Multivariate analysis revealed that all three were significant independent adverse prognostic indicators. Conclusion: Surgical resection of node-negative oesophageal cancer is associated with diverse long-term outcomes. This diversity of outcome is not reflected in the tumour node metastasis (TNM)-based staging system. The utility of the TNM system in predicting prognosis after surgical resection is open to question. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] A uniform residual tumor (R) classificationCANCER, Issue 15 2009Integration of the R classification, the circumferential margin status Abstract BACKGROUND: Since the introduction of the TNM residual tumor (R) classification, the involvement of resection margins has been defined either as a microscopic (R1) or a macroscopic (R2) demonstration of tumor directly at the resection margin ("tumor transected"). METHODS: The recognition of the importance of the circumferential resection margin (CRM) in patients with rectal cancer patients raises the need for an alternative definition of resection margin involvement, namely, the importance of delineating tumor with a minimal distance from the CRM of ,1 mm (CRM-positive) from tumor directly at the resection margin. The different use of both definitions of resection margin involvement prevents valid comparisons between reports on treatment results. RESULTS: To avoid confusion by different definitions, the authors proposed including the minimal distance between tumor and resection margin into the current R classification. CONCLUSIONS: By using the proposed expanded classification, comparisons of new data with previous publications will be possible. Cancer 2009. © 2009 American Cancer Society. [source] 4362: Iodine-125 orbital irradiation : improvement of cosmetic results for patients needing postenucleation irradiationACTA OPHTHALMOLOGICA, Issue 2010C LEVY-GABRIEL Purpose Patients enucleated for malignant intraocular tumors (as retinoblastoma or uveal melanoma) that have extrascleral extension and/or optic nerve resection margin involvement, are at risk of orbital recurrence. These enucleated orbits were previously treated with external beam radiotherapy which induced late sequelae, in particular facial atrophy. Iodine 125 Orbital brachytherapy (BRT) was first realised in 1983 in South Africa as a technique to irradiate the content of the orbit while minimizing the dose to the surrounding bone and eyelids. We report our experience since 2000 with this technique Methods Six nylon tubes containing 125 I seeds were implanted though the eyelids around the periphery of the orbit. Each contained a metal gutter that screened the outer part of the seeds from the bony orbit. A seventh unscreened tube was placed in the center and a golden plaque with 125 I seeds on its inner surface was secured beneath the eyelid. The reference dose around the target was 45 Gy for retinoblastoma and 60 Gy for uveal melanoma Results Since 2000 13 patients underwent BRT : 9 retinoblastomas (median follow up 36 months, 1 child died of craniospinal metastasis), 3 uveal melanomas (median follow up 55 months, 1 patient developed a metastatic disease), and 1 medulloepithelioma (median follow up 45 months). No patient developed orbital recurrence after BRT. Regarding cosmesis, results were much more acceptable than with other forms of irradiation with a normal size prothesis adaptation Conclusion 125 I orbital brachytherapy is an effective method of irradiating the orbit to prevent recurrent tumor after enucleation with better cosmesis results than with other forms of irradiation, especially in case of children Commercial interest [source] | ||||||||||