Difference between revisions of "Surgical margins"
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{| class="wikitable sortable" | {| class="wikitable sortable" | ||
!Tumour | !Tumour | ||
! | !Pathologic margin | ||
!Clinical margin | |||
!System | !System | ||
|- | |- | ||
| [[Colorectal carcinoma]] | | [[Colorectal carcinoma]] | ||
| | | >1 mm<ref>{{Cite journal | last1 = Fitzgerald | first1 = TL. | last2 = Brinkley | first2 = J. | last3 = Zervos | first3 = EE. | title = Pushing the envelope beyond a centimeter in rectal cancer: oncologic implications of close, but negative margins. | journal = J Am Coll Surg | volume = 213 | issue = 5 | pages = 589-95 | month = Nov | year = 2011 | doi = 10.1016/j.jamcollsurg.2011.07.020 | PMID = 21856181 }}</ref> | ||
| 1 cm<ref name=pmid18766404>{{Cite journal | last1 = Rutkowski | first1 = A. | last2 = Bujko | first2 = K. | last3 = Nowacki | first3 = MP. | last4 = Chmielik | first4 = E. | last5 = Nasierowska-Guttmejer | first5 = A. | last6 = Wojnar | first6 = A. | title = Distal bowel surgical margin shorter than 1 cm after preoperative radiation for rectal cancer: is it safe? | journal = Ann Surg Oncol | volume = 15 | issue = 11 | pages = 3124-31 | month = Nov | year = 2008 | doi = 10.1245/s10434-008-0125-6 | PMID = 18766404 }}</ref> | |||
| [[Gastrointestinal pathology]] | | [[Gastrointestinal pathology]] | ||
|- | |- | ||
|[[Vulvar carcinoma]] | |[[Vulvar carcinoma]] | ||
| 1 cm fresh | | 1.0 cm (fresh)<ref name=pmid21669423>{{Cite journal | last1 = Palaia | first1 = I. | last2 = Bellati | first2 = F. | last3 = Calcagno | first3 = M. | last4 = Musella | first4 = A. | last5 = Perniola | first5 = G. | last6 = Panici | first6 = PB. | title = Invasive vulvar carcinoma and the question of the surgical margin. | journal = Int J Gynaecol Obstet | volume = 114 | issue = 2 | pages = 120-3 | month = Aug | year = 2011 | doi = 10.1016/j.ijgo.2011.02.012 | PMID = 21669423 }}</ref> | ||
| 0.8 cm (fixed)<ref name=pmid21669423/> | |||
| [[Gynecologic pathology]] | | [[Gynecologic pathology]] | ||
|- | |- | ||
|[[Malignant melanoma]] | |[[Malignant melanoma]] | ||
| | | [[MIS]]: 5 mm (consensus in 1992)<ref name=pmid22196979>{{Cite journal | last1 = Kunishige | first1 = JH. | last2 = Brodland | first2 = DG. | last3 = Zitelli | first3 = JA. | title = Surgical margins for melanoma in situ. | journal = J Am Acad Dermatol | volume = 66 | issue = 3 | pages = 438-44 | month = Mar | year = 2012 | doi = 10.1016/j.jaad.2011.06.019 | PMID = 22196979 }}</ref> considered inadequate<ref name=pmid19050971>{{Cite journal | last1 = Möller | first1 = MG. | last2 = Pappas-Politis | first2 = E. | last3 = Zager | first3 = JS. | last4 = Santiago | first4 = LA. | last5 = Yu | first5 = D. | last6 = Prakash | first6 = A. | last7 = Kinal | first7 = A. | last8 = Clark | first8 = GS. | last9 = Zhu | first9 = W. | title = Surgical management of melanoma-in-situ using a staged marginal and central excision technique. | journal = Ann Surg Oncol | volume = 16 | issue = 6 | pages = 1526-36 | month = Jun | year = 2009 | doi = 10.1245/s10434-008-0239-x | PMID = 19050971 }}</ref> | ||
|| "no minimum safe distance established" - CAP protocol;<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2012/SkinMelanoma_12protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2012/SkinMelanoma_12protocol.pdf]. Accessed on: 19 August 2012.</ref> | |||
| [[Dermatopathology]] | | [[Dermatopathology]] | ||
|- | |- | ||
| [[Ductal carcinoma in situ]] | | [[Ductal carcinoma in situ]] | ||
| | |||
| > 2mm<ref>{{Cite journal | last1 = Dunne | first1 = C. | last2 = Burke | first2 = JP. | last3 = Morrow | first3 = M. | last4 = Kell | first4 = MR. | title = Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. | journal = J Clin Oncol | volume = 27 | issue = 10 | pages = 1615-20 | month = Apr | year = 2009 | doi = 10.1200/JCO.2008.17.5182 | PMID = 19255332 }}</ref> | | > 2mm<ref>{{Cite journal | last1 = Dunne | first1 = C. | last2 = Burke | first2 = JP. | last3 = Morrow | first3 = M. | last4 = Kell | first4 = MR. | title = Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. | journal = J Clin Oncol | volume = 27 | issue = 10 | pages = 1615-20 | month = Apr | year = 2009 | doi = 10.1200/JCO.2008.17.5182 | PMID = 19255332 }}</ref> | ||
| [[Breast pathology]] | | [[Breast pathology]] | ||
Revision as of 00:52, 28 August 2012
The surgical margins, often simply referred to as margins, are the set of surfaces that were cut by the surgeon in order to remove the specimen from the body. The distance between the tumour and the margin is called the surgical clearance, a term that may be used interchangeably with the term surgical margin.[1] Margins are important as an incompletely removed disease process may lead to re-occurrence.
Most often, positive margins, i.e. surgical margins with disease present or "very close", suck. For example, in locally advanced rectal cancer, in one study,[2] five year survival was found to be 60%, 31% and 0% for R0 (no tumour at the margin), R1 (microscopic tumour at the margin), and R2 (macroscopic tumour at the margin) resections respectively.
What defines a positive surgical margin is dependent on the tumour and its biology.
Types of margins
- En face.
- Sample the complete surface.
- No information about the distance between the margin and lesion can be obtained.
- On edge, AKA perpendicular margin, as the cut to prepare the tissue for microscopic examination is perpendicular to the cut from the surgeon.
- Sample a subset of the surface.
- The distance between the margin and lesion can be measured.
Adequate margin
- What constitutes an adequate margin is dependent on the tumour type, as different tumours have different behaviours.
Adequate margins by tumour
| Tumour | Pathologic margin | Clinical margin | System |
|---|---|---|---|
| Colorectal carcinoma | >1 mm[3] | 1 cm[4] | Gastrointestinal pathology |
| Vulvar carcinoma | 1.0 cm (fresh)[5] | 0.8 cm (fixed)[5] | Gynecologic pathology |
| Malignant melanoma | MIS: 5 mm (consensus in 1992)[6] considered inadequate[7] | "no minimum safe distance established" - CAP protocol;[8] | Dermatopathology |
| Ductal carcinoma in situ | > 2mm[9] | Breast pathology |
See also
References
- ↑ Ng, IO.; Luk, IS.; Yuen, ST.; Lau, PW.; Pritchett, CJ.; Ng, M.; Poon, GP.; Ho, J. (Mar 1993). "Surgical lateral clearance in resected rectal carcinomas. A multivariate analysis of clinicopathologic features.". Cancer 71 (6): 1972-6. PMID 8443747.
- ↑ Larsen SG, Wiig JN, Dueland S, Giercksky KE (April 2008). "Prognostic factors after preoperative irradiation and surgery for locally advanced rectal cancer". Eur J Surg Oncol 34 (4): 410–7. doi:10.1016/j.ejso.2007.05.012. PMID 17614249.
- ↑ Fitzgerald, TL.; Brinkley, J.; Zervos, EE. (Nov 2011). "Pushing the envelope beyond a centimeter in rectal cancer: oncologic implications of close, but negative margins.". J Am Coll Surg 213 (5): 589-95. doi:10.1016/j.jamcollsurg.2011.07.020. PMID 21856181.
- ↑ Rutkowski, A.; Bujko, K.; Nowacki, MP.; Chmielik, E.; Nasierowska-Guttmejer, A.; Wojnar, A. (Nov 2008). "Distal bowel surgical margin shorter than 1 cm after preoperative radiation for rectal cancer: is it safe?". Ann Surg Oncol 15 (11): 3124-31. doi:10.1245/s10434-008-0125-6. PMID 18766404.
- ↑ 5.0 5.1 Palaia, I.; Bellati, F.; Calcagno, M.; Musella, A.; Perniola, G.; Panici, PB. (Aug 2011). "Invasive vulvar carcinoma and the question of the surgical margin.". Int J Gynaecol Obstet 114 (2): 120-3. doi:10.1016/j.ijgo.2011.02.012. PMID 21669423.
- ↑ Kunishige, JH.; Brodland, DG.; Zitelli, JA. (Mar 2012). "Surgical margins for melanoma in situ.". J Am Acad Dermatol 66 (3): 438-44. doi:10.1016/j.jaad.2011.06.019. PMID 22196979.
- ↑ Möller, MG.; Pappas-Politis, E.; Zager, JS.; Santiago, LA.; Yu, D.; Prakash, A.; Kinal, A.; Clark, GS. et al. (Jun 2009). "Surgical management of melanoma-in-situ using a staged marginal and central excision technique.". Ann Surg Oncol 16 (6): 1526-36. doi:10.1245/s10434-008-0239-x. PMID 19050971.
- ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2012/SkinMelanoma_12protocol.pdf. Accessed on: 19 August 2012.
- ↑ Dunne, C.; Burke, JP.; Morrow, M.; Kell, MR. (Apr 2009). "Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ.". J Clin Oncol 27 (10): 1615-20. doi:10.1200/JCO.2008.17.5182. PMID 19255332.