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Primary Bone Tumors
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Jeremy S. Whelan, Rob C. Pollock, Rachael E. Windsor, Mahbubl Ahmed
The mainstay of treatment for high-grade chondrosarcomas is surgery. The resection margin depends entirely on the size and site of the lesion and the adequacy of pre-operative planning. Although meticulous planning of approach and planes of dissection minimizes the risk of local contamination, in reality, the excision margins are frequently marginal in at least one area where the tumor is adjacent to critical neurovascular structures. This is particularly so for large pelvic tumors. Curettage of such lesions is never curative and prevents secondary surgery from ever being successful. In the elderly and debilitated, intra-lesional surgery may be contemplated for palliation where the physical cost of curative surgery is too great. In the young, however, where cure is essential, ablative surgery with reasonable margins must be undertaken to prevent a distressing prolonged illness consisting of progressive locally recurrent disease.
Upper GI Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Nicola C Tanner, Chris Collins
What are the treatment options?UK guidelines (AUGIS consensus group 2009) recommend that small asymptomatic incidental GISTs may be observed as long as there is no change in size on serial scanning over 1–2 years.Large symptomatic GISTs should be resected, but only if complete resection can be achieved with negative resection margins (R0 resection). It is vitally important that the tumour not be ruptured during surgery as this and/or a positive resection margin leads to a dramatic reduction in survival.27 En bloc resections should be performed if adjacent organs are involved.In the stomach depending on the site and size of the GIST, an R0 resection may involve a partial, subtotal or total gastrectomy. However, a ‘wedge’ or ‘sleeve’ resection can be utilised to preserve as much stomach as possible. For small tumours this may be performed laparoscopically.Palliative surgery may have a role in selected patients for the alleviation of symptoms.Unresectable or metastatic GISTs can be treated with Imatinib (Glivec).
Pathology and Staging of Colorectal Adenoma and Adenocarcinoma
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
In the laboratory, the resected specimens should be processed in a systematic manner to provide a complete and accurate pathology report. Ideally, the specimens should be received fresh and unopened and should be transferred to the laboratory soon after surgery. The specimen should be fixed for at least 24–48 hours in formalin, keeping the tumour segment intact. The serosal surface should be inspected and the radial margin should be examined, and any tumour perforation should be noted. For anterior resection and abdomino-perineal excisions, the mesorectal surface is carefully examined and preferably photographed. The circumferential (non-peritonealised) surgical resection margin is inked to enable identification of margin involvement. The specimen is then opened anteriorly apart from a segment extending 1–2 cm above and below the tumour to avoid disruption of the tumour and margins. The specimen is then immersed in an adequate amount of formalin, and after fixation, is serially sliced. The slices are laid out for inspection and photography to enable presentation at the multidisciplinary meeting if required. At least four blocks of the tumour demonstrating the deepest area of invasion are taken, and it is also recommended to take the adjacent normal tissue in case this may be used for research in the future or for microsatellite instability investigation. Blocks to show involvement of the serosal surface should be taken, and for this purpose, blocks are taken from areas that are dulled, fibrotic or haemorrhagic.
Ultrasound-assisted resection of oral tongue cancer
Published in Acta Oto-Laryngologica, 2022
Olof Nilsson, Johan Knutsson, Fredrik J. Landström, Anders Magnuson, Mathias von Beckerath
In the study group, The BK Medical Flex Focus 500 US system with the high frequency linear 8870 probe (Peabody, MA) was used in all patients. An US frequency of 18 MHz and a gain between 50% and 65% were used along with water-based Eco gel and a transducer cover. The deep tumour margin was evaluated by US (Figure 1(a–d)). A mucosal resection margin of at least 10 mm was marked with monopolar diathermy. Deep resection was performed with either monopolar diathermy or harmonic scalpel (Ethicon Harmonic Focus + Shears, Bridgewater, NJ), again aiming for at least a 10 mm macroscopic margin. Approximately one-quarter into the resection, US examination was performed (US in-vivo), and the deep resection margin was measured in millimetres. A metal spatula was placed at the resection border for increased contrast of the US image (can be excluded since air at the resection border produces a contrast as well). The smallest pressure with the probe necessary to achieve an adequate image was applied, since different pressures could alter the assessed margin by several millimetres. This assessment was repeated approximately two- and three-quarters into the resection and finally on the whole surgical specimen after resection (US ex-vivo); the latter was used for analysis. If the US margin was under 5 mm, a wider resection was considered after inspection and palpation of the specimen. Frozen-section analysis was only used in a few resections of stage T3 tumours. The conventional group were operated on by more senior surgeons compared to the study group.
Alpha-Fetoprotein in Predicting Survival of Patients with Ruptured Hepatocellular Carcinoma after Resection
Published in Journal of Investigative Surgery, 2022
Wong Hoi She, Miu Yee Chan, Ka Wing Ma, Simon H. Y. Tsang, Wing Chiu Dai, Albert C. Y. Chan, Chung Mau Lo, Tan To Cheung
Diagnosis of rHCC has been detailed in a previous paper [11]. In patients who had no acute abdominal pain, the diagnosis was made during hepatectomy. Pre-hepatectomy management of spontaneous HCC rupture has been described in previous papers [12]. Patients who were stable at presentation were managed conservatively with tranexamic acid if no contraindications were identified. They were monitored closely by clinical and biochemical means in the minimum setting of a high dependency unit. Before 2005, patients who were fit and whose liver function had recovered were offered an early operation. Since 2005, all patients received a further computed tomographic scan (usually two to four weeks after the initial episode) to reevaluate their tumor status before operation. After initial stabilization and recovery, hepatectomy was considered and planned. Relationship between tumor’s anatomical location (regardless of tumor size) and major hepatic vasculatures would determine resectability. A 1-cm resection margin was aimed for, preferably by anatomical resection. Criteria for major resection (removal of 3 or more continuous Couinaud segments [13] have been listed in an earlier article and resection techniques have been detailed in various papers [14].
Risk factors for local recurrence of early bilateral vocal cord carcinoma treated with transoral CO2 laser microsurgery
Published in Acta Oto-Laryngologica, 2021
Chen Tan, Jugao Fang, Ru Wang, Qi Zhong, Lizhen Hou, Hongzhi Ma, Ling Feng, Shizhi He, Meng Lian, Yifan Yang
For laryngoscopy, all patients received general anaesthesia. Suspension laryngoscopy was performed, and the lesion was examined under microscopy (OPMI Vario S88, Zeiss, Oberko- chen, Germany). The tumour was removed using CO2 laser (Model 1041S, Sharplan, Tel Aviv, Israel) with resection margins of 3–4 mm. For tumours with a suspicious visual appearance, frozen pathological sections were prepared for further analysis. In cases with a negative resection margin, the operation was completed; for cases with a positive resection margin, resection margins were extended by a further 2 mm until margins were negative. Surgical specimens were sent routinely for postoperative pathological examination. As intraoperative freezing increases false-negative results, we performed statistical analyses on pathological test results to determine whether resection margins were positive.