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

Abstract

Introduction Sublobar resection in primary lung cancer and pulmonary metastatic tumor can result in recurrence at the surgical margin. Confirming the absence of tumor cells at the cut-end is important. We sought to evaluate the efficacy of intraoperative lavage cytology (ILC) of autostapling cartridges in preventing local failure. Materials and methods An intraoperative cytology examination was performed in 262 consecutive patients undergoing wedge or segmental resection for 311 lesions, including primary lung cancers and pulmonary metastatic tumors, between April 2004 and April 2010. The data of patients with positive cytology results and those who developed local failure were retrospectively reviewed. Results A total of 139 primary lung cancers and 172 pulmonary metastatic tumors (primary site: 120 colorectal and 52 others) were investigated. The results revealed 22 (7%) positive cytology results (11 primary and 11 metastatic). The resection margins of 19 of the 22 lesions with positive cytology were additionally resected. With a median follow-up period of 42 months, recurrence at the margin developed in 2 of the 19 lesions in which additional resection was performed (11%, 1 primary and 1 metastatic). Recurrence at the margin developed in 2 (67%, 1 primary and 1 metastatic) of the 3 lesions in which additional resection was abandoned. Among the 289 lesions showing negative cytology results, recurrence at the margin developed in 7 (2%, 6 primary and 1 metastatic). Conclusions ILC of autostapling cartridges in sublobar resection for pulmonary malignant tumor may be useful for assessing the cytological status of the surgical margin.

The difference of auxiliary examination parameters between margin recurrence and granuloma on enhanced computed tomography after sublobar resection

“…As for segmentectomy, excluding the three patients who underwent palliative resection, the CT images and postoperative pathology of the other nine patients showed higher tumor malignancy than the three patients who underwent wedge resection. This is also in line with the view of some researchers that the malignancy of the first lung tumor is proportional to the recurrence probability after sublobar resection ( 12 , 16 ). Additionally, some researchers have suggested that defects in intraoperative frozen pathology techniques may be a major reason for recurrence at surgical margins.…”

“…The maximum standardized FDG uptake value (SUVmax) of the mass on the lungs of these patients and the CT value of the mass were recorded by enhanced CT. At the same time, the patient’s medical history was collected before and after the pathological results of the patient’s first operation. Patients with a tumor diameter >2.0 cm, solid tumor, presence of vascular invasion or lymphatic infiltration, visceral pleural invasion, or tumor spread through air spaces (STAS) were defined as high risk ( 16 ). The specific surgical methods, surgical sites, and other data were also collected.…”

Intraoperative cone-beam computed tomography to secure the surgical margin in pulmonary wedge resection for indistinct intrapulmonary lesions

“…We routinely performed irrigation of any cartridges used in pulmonary stapling to make a rapid cytological diagnosis of surgical stump positivity. 14 We generally make additional resection if the irrigation cytology was positive.…”

Intraoperative computed tomography of a resected lung inflated with air to verify safety surgical margin

“…We routinely performed irrigation of any cartridges used in the pulmonary stapling in order to make a rapid cytological diagnosis for surgical stump positivity (7). After intraoperative CT, the specimen was instilled with 10% formalin neutral buffer solution using a 23-G needle and then soaked in the solution for 48 h. After removing the stapler needles from the staple line, the specimen was cut into pieces for macroscopic and microscopic evaluations of the tumor diameter and surgical margin.…”