BACKGROUND: The principle of Mohs micrographic surgery is to examine microscopically the entire peripheral margin of an excised tissue specimen to precisely localize the site of any residual tumor and enable its subsequent removal. In processing in the tissue for frozen horizontal sections, a technical difficulty arises in manipulating the deep and lateral margins into the same flat plane. OBJECTIVE: Our aim was to develop a new method allowing the optimal tissue preperation for Mohs micrographic smgery and to evaluate the usefulness of this methad. METHODS: The technique involves conversion of a non-planar surgical margin to a planar surface by applying and freezing the specimen against a flat glass surface. We compared this modified method used in our laboratory with standard methods for tissue preparation of Mohs micrographic surgery.
Freezing ; Glass ; Mohs Surgery ; Neoplasm, Residual

Dermatofibrosarcoma protuberans is a dermal spindle cell neoplasm of intermediate malignancy, and is characterized by a high local recurrence rate after surgical excision due to its aggressive, finger-like outgrowth pattern. Mohs micrographic surgery, which ensures complete excision of the tumor and minimizes normal tissue loss, is accepted as the treatment of choice for dermatofibrosarcoma protuberans. However, the use of frozen sections for margin control in dermatofibrosarcoma protuberans is controversial because it could be difficult to differentiate minimal residual tumor from normal skin on the frozen sections, and is more challenging in recurrent disease because of the scar tissue. We report a case of a recurrent dermatofibrosarcoma protuberans in which the tumor was excised using the Mohs surgical technique and margin control was achieved with horizontally-cut paraffin-embedded permanent sections, named as rush permanent sections.
Cicatrix ; Dermatofibrosarcoma* ; Frozen Sections ; Mohs Surgery* ; Neoplasm, Residual ; Recurrence ; Skin

OBJECTIVETo evaluate the rate of residual disease in the thyroid gland and rate of cervical lymph node metastasis after preliminary local resections in thyroid cancer.

METHODSFrom 1994 - 1999, 160 thyroid cancer patients who had previously been treated with nodulectomy or subtotal lobectomy in other hospitals were reoperated.

RESULTSThe rate of residual disease at the primary site was 42.5%. The lymph node metastatic rate at level VI was 28.1%. The rate of lymph node metastasis in those with enlarged lymph nodes in the ipsilateral internal jugular chain was 35.4%. The rate of laryngeal recurrent nerve injury was 12.5% at the first operation which is much higher than that of the second operation (1.9%).

CONCLUSIONBecause of the high rate of local residual disease, nodulectomy or subtotal lobectomy alone is not indicated for thyroid cancer. The exploration to level VI is needed for thyroid cancer. It is of utmost importance to be familiar with laryngeal recurrent nerve anatomy in thyroid surgery.

Adult ; Female ; Humans ; Male ; Neoplasm Recurrence, Local ; surgery ; Neoplasm, Residual ; surgery ; Thyroid Gland ; pathology ; surgery ; Thyroid Neoplasms ; surgery ; Thyroidectomy

OBJECTIVETo study the role of secondary cytoreductive surgery (SCR) in patients with recurrent advanced epithelial ovarian cancer.

METHODSFrom Jan. 1986 to Dec. 1997, 60 women with recurrent advanced epithelial ovarian cancer treated with SCR were retrospectively reviewed. Survival curves were computed using the Kaplan-Meier method with differences in survival estimated by log-rank test. Independent prognostic factors were identified by Cox's stepwise regression, and the affecting factors of SCR evaluated by Logistic stepwise regression.

RESULTSOf the 60 patients, 23 (38.3%) were cytoreduced to small macroscopic residual (residual, with an estimated median survival of 19 months and 8 months respectively. Multivariate analysis revealed that residual disease (P = 0.0041) after SCR, as well as refractory ascites (P = 0.0191) and progression-free interval (P = 0.0116), were independent factors of survival. Refractory ascites (relative risk = 20.36, P = 0.0072) and residual disease after primary surgery (relative risk = 5.16, P = 0.0096) were factors affecting SCR.

CONCLUSIONSecondary cytoreductive surgery is definitely effective in the treatment of recurrent advanced epithelial ovarian carcinoma, particularly in those who have received primary optimal cytoreduction with a progression-free interval > 12 months and without refractory ascites.

Adult ; Female ; Humans ; Logistic Models ; Middle Aged ; Neoplasm Recurrence, Local ; surgery ; Neoplasm, Residual ; surgery ; Ovarian Neoplasms ; surgery ; Prognosis ; Survival Analysis

Radiotherapy is the primary curative treatment of nasopharyngeal carcinoma (NPC) with the dose-response relationship. Local recurrence is one of the major treatment failure patterns. With high accuracy, high tumor dose, high therapeutic enhancement ratio and low normal tissue dose, stereotactic radiotherapy (SRT) is used as boost irradiation for residual lesions and is able to improve the local control rate. Residual lesions involving the carotid artery or cavernous sinus, or with tumor necrosis are treatment contraindications to SRT boost irradiation; while the old patients, patients with hypertension, diabetes mellitus, and severe nasopharyngeal infection are relative treatment contraindications to SRT boost irradiation. Fractionated SRT can spare vessels and nerves better than stereotactic radiosurgery (SRS). SRT can definitely improve the outcome for the boost of NPC residual lesions. Proper patient selection, individualized fractionated regimen, and balance of the benefit of tumor control and the risk of normal tissue damage are of paramount importance to ensure the satisfactory clinical outcome and quality of life.
Dose Fractionation ; Humans ; Nasopharyngeal Neoplasms ; pathology ; surgery ; Neoplasm Recurrence, Local ; Neoplasm, Residual ; Quality of Life ; Radiosurgery ; methods ; Radiotherapy Dosage ; Treatment Outcome

BACKGROUND: The relationship between surgical margin and local recurrence (LR) in osteosarcoma patients with poor responses to chemotherapy is unclear. Moreover, the incidences of LR according to three different resection planes (bone, soft tissue, and perineurovascular) are not commonly known. METHODS: We evaluated the incidence of LR in three areas. To assess whether there is a role of surgical margin on LR in patients resistant to preoperative chemotherapy, we designed a case (35 patients with LR) and control (70 patients without LR) study. Controls were matched for age, location, initial tumor volume, and tumor volume change during preoperative chemotherapy. RESULTS: LR occurred at the soft tissues in 18 cases (51.4%), at the perineurovascular tissues in 11 cases (31.4%), and at the bones in six cases (17.2%). The proportion of inadequate perineurovascular margin was higher in the case group than in the control group (p = 0.01). Within case-control group (105 patients), a correlation between each margin status and LR at corresponding area was found in the bone (p < 0.001) and perineurovascular area (p = 0.001). CONCLUSIONS: LR is most common in soft tissues. In patients showing similar unfavorable responses to chemotherapy, the losses of perineurovascular fat plane on preoperative magnetic resonance imaging may be a valuable finding in predicting LR.
Adolescent ; Bone Neoplasms/*pathology/radiography/*surgery ; Case-Control Studies ; Chi-Square Distribution ; Female ; Humans ; Male ; Neoplasm Recurrence, Local/*pathology ; Neoplasm, Residual/pathology ; Osteosarcoma/*pathology/radiography/*surgery

OBJECTIVESTo analyze associated factors and the prognosis of patients with residual cancer after esophagectomy for squamous cell carcinoma of the esophagus, and to assess outcomes after salvage treatment.

METHODSClinical and pathological data of 1074 patients with squamous cell carcinoma of the esophagus who underwent esophagectomy in the Cancer Center of Sun Yat-sen University from 1997 to 2003 were analyzed retrospectively. The relationship between the associated factors (differentiation, location, length of the lesion, surgical route, anastomosis site, T stage, N stage) and the incidence of residual cancer was analyzed, using the chi-squared test and Logistic regression analysis methods. The value and the modality of the salvage treatment were investigated.

RESULTSForty-four patients had residual cancer (4.3%). Cancers in the upper esophagus were associated with the highest incidence of residual cancer on esophageal stump (6.5%), while the lower esophagus had the highest incidence of residual cancer on gastric stump (0.78%). The Incidence correlated with T and N stage. Logistic regression analysis showed that T and N stage were the risk factors of residual cancer. Three-year survival rate was 22.7% in patients with residual cancer. The mean survival time was 25.2+/-3.3 months. Three-year survival rates of patients with and without salvage treatment were 53.2% and 7.8%, respectively (P=0.027). Three-year survival rate of patients with salvage radiotherapy was 56.0%.

CONCLUSIONSAdvanced T and N stage are the risk factors of residual cancer after esophagectomy in the patients with squamous cell carcinoma of the esophagus. Salvage treatment can improve the survival of the patients.

Adult ; Aged ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; surgery ; Esophageal Neoplasms ; diagnosis ; pathology ; surgery ; Esophagectomy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm, Residual ; epidemiology ; Prognosis ; Retrospective Studies

Lung cancer is the most common malignant tumor in the world, among which non-small cell lung cancer (NSCLC) accounts for about 85% of the total number of lung cancers. The 5-year overall survial (OS) of radical surgery NSCLC patients ranged from 92% in stage Ia1 to 26% in stage IIIb, and the continuously decreasing survival time made it a strong clinical need for precise adjuvant therapy to eradicate molecular residual disease (MRD). At present, circulating tumor DNA (ctDNA) as a molecular indicator of MRD has gradually moved from the laboratory to the clinic. The latest consensus proposes that ctDNA with abundance ≥0.02% can be stably detected in the peripheral blood of perioperative NSCLC patients, which is based on the possibility of ctDNA as an MRD indicator. MRD detection technology supports the possibility of monitoring after radical treatment of NSCLC, and ctDNA can predict the recurrence of the disease earlier than the imaging monitoring after treatment of NSCLC, providing valuable time for timely adjustment of adjuvant therapy. In the studies on early postoperative adjuvant therapy of NSCLC, different guidelines differ on whether appropriate adjuvant therapy should be carried out, while MRD can be used as a more accurate predictor to guide postoperative adjuvant therapy, so that patients can benefit from the disease treatment.
.
Biomarkers, Tumor ; Carcinoma, Non-Small-Cell Lung/surgery* ; Circulating Tumor DNA ; Humans ; Lung Neoplasms/surgery* ; Neoplasm Recurrence, Local ; Neoplasm, Residual ; Small Cell Lung Carcinoma

Ameloblastoma is cytologically a benign tumor, but is clinically characterized by infiltrative growth and high recurrency. The criteria for surgical treatment of ameloblastoma has not yet established and it is generally accepted that ameloblastoma be treated differently based on clinical types. The purpose of this paper is to consider effectiveness of enucleation in large-sized intraosseous ameloblastoma that has treated more frequently by radical treatment. 39 cases of the intraosseous ameloblastomas were treated by enucleation in the department of oral and maxillofacial surgery of Yonsei University, dental college from February 1990 to January 2001. 25 cases were selected because they were large in size that could produce facial disfigurement or pathologic fracture of jaws. They were radiographically characterized by the cortical bone that was expanded or eroded locally and histopathologically by 19 solid ameloblastomas and 6 intramural type of unicystic ameloblastomas. Among the 25 cases, 4 cases - 3 solid ameloblastomas and 1 intramural type of ameloblastoma - recurred. Recurrence rate was 16%. The compact bone which is not invaded by ameloblastoma was used as surgical margin of enucleation with accompanying chemical cauterization for killing the residual tumor cells. This may have been the reason for the low recurrence rate. So, it is considered that enucleation and long-term follow-up enable the large-sized intraosseous ameloblastomas that were characterized by almost destroyed cancellous bone and expanded or discontinued cortical bone to treat minimizing facial disfigurement and masticatory dysfunction and sociopsychological impact produced by radical treatment. I recommend that the large-sized intraosseous ameloblastomas without involvement to the surrounding soft tissues be first treated by enucleation.
Ameloblastoma* ; Cautery ; Cytochrome P-450 CYP1A1 ; Follow-Up Studies ; Fractures, Spontaneous ; Homicide ; Jaw ; Neoplasm, Residual ; Recurrence ; Surgery, Oral

Antineoplastic Agents ; therapeutic use ; Breast ; pathology ; Breast Neoplasms ; drug therapy ; pathology ; surgery ; Female ; Humans ; Lymphatic Metastasis ; Neoadjuvant Therapy ; Neoplasm, Residual