Intraoperative Lavage Cytologic Analysis of Surgical Margins as a Predictor of Local Recurrence in Pulmonary Metastasectomy

Abstract

Hypothesis: Cytologic analysis of intraoperative lavage at the surgical margin during wedge or segmental resection for pulmonary metastatic lesions predicts postoperative local failure at the surgical margin of the pulmonary parenchyma.Design: Prospective nonrandomized trial.Settings: Institution-based study.Patients: Fifty-one consecutive patients undergoing wedge or segmental resection for 87 pulmonary metastatic lesions of various primary tumor types from November 1, 1997, through January 31, 2001, were prospectively enrolled.Interventions: An intraoperative lavage cytologic technique at the surgical margin for each pulmonary metastasis was performed as described previously.Main Outcome Measures: Incidence of positive cytologic findings and postoperative local recurrence at the surgical margin.

Stapling cartridge lavage cytology in limited resection for pulmonary malignant tumors: assessment of cytological status of the surgical margin

“…The use of autostapling devices to cut and staple the lung parenchyma is widespread, and ILC of the autostapling cartridge used in limited lung resection is an effective technique to confirm a microscopically negative surgical margin during surgery [15, 16]. Higsahiyama et al.…”

“…Although limited lung resection has the advantage of preserving lung parenchyma, an increased risk of local recurrence at the surgical margin has been observed [12, 13, 14, 15, 16, 17, 18, 19], even in patients whose macroscopic resection margin was sufficiently secured. To prevent local failure, several methods such as frozen section analysis or stamped cytologic examination were reported to assess residual tumor cells at the cut-end during surgery [20].…”

“…Higashiyama et al. showed that employing intraoperative lavage cytology (ILC) of autostapling cartridges used to cut lung parenchyma was effective in reducing recurrence at the resection margin [15, 16]. They speculated that ILC of autostapling cartridges was superior to conventional techniques because the entire area of the margins can be collectively examined, and each margin can be tested separately if necessary.…”

Midterm Local Efficacy and Survival after Radiofrequency Ablation of Lung Tumors with Minimum Follow-up of 1 Year: Prospective Evaluation

“…Incomplete resection is considered to be accurately and reliably confirmed by means of these examinations. However, such macroscopic or histologic examination results probably underestimated the rate of incomplete resection, as demonstrated in a series of 51 consecutive patients, in which macroscopic and pathologic examination findings were 0% and 4.6%, respectively, while intraoperative pleural lavage cytologic evaluation revealed tumor cells in 11% of cases (12). The best way to ascertain incomplete local treatment is probably long-term follow-up imaging, carefully scrutinizing the resection bed, but this type of evaluation is difficult to obtain from most surgical series where the terms "local or locoregional recurrence" may in fact signify incomplete local treatment or a new tumor in the lung and, in some series, an involved hilar lymph node.…”

“…Indeed, the rate of incomplete resection is linked to the tumor size in many reports, and tumors exceeding 1 cm recurred more often for Higashiyama et al (12), while 2 cm was the threshold for Yano et al (14). The high success rate of complete RF ablation of lung tumors reported herein is obviously due to a very strict selection of tumor sizes (Ͻ4 cm), which allowed us to oversize the ablation volume compared with the tumor size.…”