Gastrointestinal Neoplasms ; pathology ; Humans ; Neoplasm Recurrence, Local ; surgery ; Postoperative Period

OBJECTIVETo study the micrometastasis distribution in liver tissue surrounding hepatocellular carcinoma (HCC), and provide reference for appropriate surgical safety margin.

METHODSThirty-six patients with HCC but without clinical metastasis underwent hepatectomy. Their specimens showing ample surgical margin were made into giant sections. Tumor micrometastasis in liver tissue around the primary tumor were examined microscopically. In each specimen, the surrounding tissue was divided into proximal(p) and distal(d) areas. In either area, three lines of demarcation 0.5 cm, 1.0 cm, and 2.0 cm away from the margin of the primary tumor were designated as L(0.5), L(1.0) and L(2.0). Therefore, the surrounding tissue was divided into six zones - Z(p0.5), Z(p1.0), Z(p2.0) and Z(d0.5), Z(d1.0), Z(d2.0). The maximum micrometastasis spread distance (MMSD) and density (D(p0.5), D(p1.0), D(p2.0) and D(d0.5), D(d1.0), D(d2.0)) in each zone were analyzed after search for micrometastasis in the giant sections.

RESULTS72.5% (111/153) micrometastases were found in form of microscopic tumor emboli. Their spread distance could be up to 6.1 cm. In 66.7% (24/36) specimens, micrometastases were found in the surrounding tissue. In 91.7% (22/24) of them, the distal MMSD was less than 3 cm. The proximal MMSD was less than 1.5 cm in 92.3% (12/13). The comparison of micrometastasis density in the different zones were D(d0.5) > D(d1.0) > D(d 2.0); D(p0.5) > D(p1.0) > D(p2.0); D(d1.0) > D(p1.0); D(d2.0) > D(p2.0) with significant differences.

CONCLUSION(1) Micrometastases of HCC exist mainly in form of microscopic tumor emboli, (2) The longer the distance from the primary focus, the lower the micrometastasis incidence, (3) In zones more than 0.5 cm away from the primary focus, tumor micrometastasis incidence is significantly lower in the proximal zones than that in the distal zones and (4) For HCC patients without clinical metastasis, a surgical margin of 3 cm wide in the distal area and 1.5 cm wide in the proximal area may reduce the rate of postoperative recurrence.

Carcinoma, Hepatocellular ; secondary ; surgery ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; pathology ; surgery ; Neoplasm Metastasis ; Neoplasm Recurrence, Local

Adult ; Epiglottis ; Humans ; Laryngeal Neoplasms ; pathology ; surgery ; Male ; Neoplasm Recurrence, Local ; Sarcoma, Synovial ; pathology ; surgery

Humans ; Nasopharyngeal Carcinoma/pathology* ; Neoplasm Recurrence, Local/pathology* ; Skull Base/surgery* ; Nasopharyngeal Neoplasms/pathology* ; Head

OBJECTIVETo evaluate the risk factors for recurrence in patients with hepatocellular carcinoma (HCC) after liver transplantation (LT).

METHODSOne hundred and fifteen small HCC patients, who met Milan criteria (single<5 cm or showing up to three nodules, each of them<3 cm without major vascular invasion or distant metastasis) and underwent LT in our hospital from January 2007 to November 2013, were enrolled in the study. The risk factors for recurrence were analyzed by Cox regression and the influence of the Milan criteria and microvascular invasion (MVI) on the disease-free survival (DFS) and recurrence of patients were assessed with survival analysis and ROC method.

RESULTSNinety-eight out of 115 small HCC patients were included for analysis, the 1-,3-, 5-year overall survival of patients was 91.8%, 80.6%, 79.6% and DFS was 87.8%, 74.5%, 73.5%, respectively. Survival analysis identified that MVI, macro-vascular invasion, exceeding the Milan criteria and pre-transplant down-staging treatment were related to tumor recurrence (P<0.05). Multivariate Cox regression analysis showed that MVI and exceeding the Milan criteria were two independent prognostic indicators for early recurrence of small HCC after LT. The 1-,3-,5-year DFS for 69 patients without MVI and 29 patients with MVI were 92.8%, 85.5%, 85.5% and 75.9%, 55.2%, 48.3%, respectively (P<0.01). The 1-,3-,5-year DFS for 84 patients meeting the Milan criteria and 14 exceeding the Milan criteria were 91.7%, 83.3%, 79.8% and 64.3%, 42.9%, 42.9%, respectively (P<0.01).

CONCLUSIONFor early HCC patients undergoing LT, the presence of MVI would predict tumor recurrence and can be an indicator for the adjuvant treatment or other salvage treatments.

Carcinoma, Hepatocellular ; pathology ; surgery ; Humans ; Liver Neoplasms ; pathology ; surgery ; Liver Transplantation ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; pathology ; Prognosis ; Risk Factors

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

Anal Canal ; surgery ; Humans ; Neoplasm Recurrence, Local ; prevention & control ; Rectal Neoplasms ; pathology ; surgery

OBJECTIVETo examine the feasibility and safety of gastric submucosal tunnel dissection of gastric submucosal tumors (SMTs) by double tunnel and double flex endoscope.

METHODSFifty patients with gastric SMTs detected by gastric endoscopy and endoscopic ultrasonography between January, 2012 and August, 2013 were enrolled in this study. Using carbon dioxide throughout the procedure, the mucous in the arc was incised along the margins of the lesion to separate the submucosa and create a tunnel. The exposed SMTs were resected completely and the mucosa was covered by endoscopic forceps followed by clipping of the incision. The complication, clinical outcomes, hospital stays and operation time were evaluated.

RESULTSOf the 50 lesions, 50 were located in the gastric fundus, 17 in the gastric antrum and 5 in the gastric body. The lesions were completely resected in all the patients. The diameter of the resected lesions ranged from 0.5 to 2.5 cm (mean 1.1 ± 0.6 cm), and the operation lasted for 35.3 ± 16.2 min (range 23-76 min). In 5 cases (10%), perforation occurred during the operation and was closed by clipping the incision with endoclips after the lesion resection; these patients were discharged after conservative management. Intraoperative bleeding occurred in 16 cases and was successfully managed through endoscopic methods. No delayed postoperative bleeding or perforation occurred in these patients. None of the 48 patients followed up showed tumor recurrence at one year after the operation, and 2 patients were lost for follow up.

CONCLUSIONEndoscopic submucosal dissection of gastric SMTs is effective and safe using double tunnel and double flex endoscope.

Dissection ; Endoscopes ; Endoscopy ; Endosonography ; Gastric Mucosa ; pathology ; surgery ; Humans ; Neoplasm Recurrence, Local ; Stomach Neoplasms ; surgery

Gastric stump cancer(GSC) is defined as newly developed remnant stomach cancer following gastrectomy. This definition initially referred to carcinoma detected in the remnant stomach more than 5 years after the primary surgery for a benign disease. Subsequently, this timeframe was extended to 10 years after the primary surgery for a malignant disease. Recently, the concept of "carcinoma in the remnant stomach(CRS)" proposed by the Japanese Gastric Cancer Association was introduced in China. The new definition encompasses all carcinomas arising in the remnant stomach following gastrectomy, irrespective of the histology of the primary lesion, extent of resection, or reconstruction method. It includes all carcinoma types that have developed in the remnant stomach, such as newly developed cancer, recurrent cancer, remaining cancer, and multiple cancers. Considering the current diagnosis and treatment status of gastric cancer in China, if CRS is to be used as a direct equivalent to GSC in clinical practice, confusion may arise concerning disease identification and diagnosis. Following several discussion rounds, a meta-analysis of the literatures at home and abroad, and a multicenter national retrospective study with a large sample population, the "Chinese surgeons' consensus opinion for the definition of gastric stump cancer (version 2018)" was completed. By reviewing the detailed evidence-based medicine supporting the consensus document, this paper aims to assist clinical diagnosis and enhance future academic exchange.
China ; Consensus ; Gastrectomy ; Gastric Stump ; pathology ; surgery ; Humans ; Neoplasm Recurrence, Local ; Retrospective Studies ; Stomach Neoplasms ; surgery

Humans ; Neoplasm Recurrence, Local ; prevention & control ; Pelvis ; pathology ; Postoperative Period ; Rectal Neoplasms ; pathology ; surgery