Surgical margins

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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.

See also

References

  1. 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.
  2. 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.