INTRODUCTION: Currently, the predominant question is whether a laparoscopic approach is comparatively radical in comparison with an open access approach, especially in the circumferential resection margin and quality of the completeness of total mesorectal excision. These factors are important in determining the quality of surgical care as well as long-term results of the treatment. AIM: This article focuses on the evaluation of circumferential resection margins and on the quality of mesorectal excision of middle and lower rectum tumors. In addition, laparoscopic and open techniques are compared. MATERIAL AND METHODS: Data were collected prospectively and stored in a rectal cancer registry over a 3-year period. The parameters studied were age, sex, body mass index, localization and topography of the tumor, clinical stage, neoadjuvant chemotherapy and its response, the type of surgery, character of the circumferential and distal margins, quality of the mesorectal excision, pT and pN. RESULTS: One hundred and twenty-five patients were chosen for our study. Laparoscopy was performed in 53 operations and a conventional approach was performed in 72 operations. Complete mesorectal excision was achieved in 54.7% of laparoscopic operations versus 44.4% in the conventional technique; partially complete excision was performed in 20.8 and 12.5%, respectively. Incomplete excisions were described in 24.5 and 43.1% (p = 0.085). Positive circumferential margin occurred during laparoscopic surgery in 11 (20.8%) patients, and in the case of conventional resection in 27 (37.5%) patients (p = 0.044). CONCLUSIONS: Our study showed comparable results between laparoscopic and open access procedures during rectal resection. The results achieved, in particular in the quality of the mesorectal excision and negative circumferential resection margin, show that the laparoscopic approach is comparable to conventional surgical techniques, with an adequate surgical outcome, in the treatment of rectal cancer.

• Publikační typ
• časopisecké články MeSH

Úvod: Sérový prostatický specifický antigen (PSA) je nenahraditelný marker v detekci i v dalším sledování pacientů s karcinomem prostaty. V naší analýze se věnujeme faktorům, které by mohly poukázat na pravděpodobnost recidivy časně po radikální prostatektomii. Zabýváme se především pozitivním chirurgickým okrajem (R1). Metody: Retrospektivní hodnocení a analýza databáze pacientů s karcinomem prostaty po radikální prostatektomii od roku 2001 do roku 2019. Celkem se studie účastnilo 1529 pacientů, střední doba sledování byla 48 měsíců, věk pacientů byl od 49 do 76 let. Využili jsme předoperační hodnoty PSA, sledování dynamiky vývoje PSA 3. generace (detekční limit 0,003 ng/ml) po operaci v intervalech 1. měsíc po operaci, 3. měsíc po operaci a dále v 3 měsíčních intervalech. Sledovali jsme pozitivitu chirurgického resekčního okraje (R0 negativní, R1 pozitivní) a Gleason skóre (GS) z histologického preparátu a analyzovali vztah k biochemické recidivě onemocnění. Výsledky: Hodnota PSA před operací neprokázala přímou souvislost s rizikem R1. Hodnoty pacientů skupiny R1 a R0 se lišily pouze o 1,159 ng/ml (p=NS). Hodnota PSA 3. generace 1. měsíc od operace byla u pacientů skupiny R1 o 50,82 % vyšší (p>0,001). 50 % pacientů s R1, kterých bylo celkem 29,5 %, po dobu sledování dosáhlo BCR, zatímco u pacientů s R0, kterých bylo celkem 70,5 %, bylo toto zastoupení 30 % (p>0,001). Skupina pacientů GS 6–7 dosáhla BCR z 47 %. Skupina s GS 8–10 recidivovala v 75 % případů (p>0,001). Závěr: Stadia biochemické recidivy dle naší analýzy dosáhlo 33 % pacientů. Riziko recidivy jsme prokázali v přímé závislosti závěrečného Gleason skóre. Přítomnost R1 by neměla být přímou indikací k adjuvantní radioterapii.

Introduction: Serum prostate specific antigen (PSA) is an irreplaceable marker in the detection and follow-up of patients with prostate cancer. In our analysis we addressed factors that could indicate the likelihood of biochemical recurrence (BCR) early after radical prostatectomy. We mainly focused on the positive surgical margin (R1). Methods: Retrospective evaluation and analysis of the database of patients with prostate cancer after radical prostatectomy from 2001 to 2019. In total 1529 patients were enrolled in the study. The median follow-up was 48 months. The age of the patients ranged from 49 to 76 years. We used pre-operative PSA values, and the monitoring of the dynamics of 3rd generation PSA progression (detection limit 0.003 ng/ml) at month 1 and month 3 after surgery and then in 3-month intervals. We monitored the surgical margin positivity (R0 negative, R1 positive) and the Gleason score (GS) based on histological samples and we analysed the relationship to biochemical recurrence of the disease. Results: The pre-operative PSA value did not show a direct relationship to the R1 risk. Patient values in the groups R1 and R0 differed only by 1.159 ng/ml (p=NS). The 3rd generation PSA value at month 1 after surgery was 50.82% higher in R1 patients (p>0.001). 50% of patients with R1 (29.5% patients of the total) did develop BCR during the follow-up period, while in patients with R0 (70.5% patients of the total) this proportion was 30% (p>0.001). Among those with GS 6−7, 47% developed BCR. The GS 8−10 group relapsed in 75% of the cases (p>0.001). Conclusion: According to our analysis 33% of the patients reached the stage of biochemical recurrence. We demonstrated a direct dependency between the risk of recurrence and the final Gleason score. The presence of R1 should not be viewed as a direct indication for adjuvant radiotherapy.

• MeSH
• lidé MeSH
• lokální recidiva nádoru MeSH
• nádory prostaty * chirurgie   MeSH
• prostatektomie MeSH
• prostatický specifický antigen MeSH
• resekční okraje * MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH

Úvod: Konzervativní výkony jsou alternativou radikální mastektomie. Rozsah resekce je předmětem diskuzí, stejně jako přítomnost reziduálních maligních buněk v prsu po excizi a jejich vliv na vznik lokálních recidiv. Cílem studie bylo zjistit přítomnost reziduálních buněk v reresekovaných tkáních při pozitivních okrajích, ve vzdálenosti do 2 mm a 2−5 mm. Vzdálenost více než 5 mm byla hodnocena jako volný okraj. Metoda: Do studie byly zařazeny všechny pacientky operované v nemocnici Atlas od roku 2004 do 2008 s konzervativním výkonem. Resekční linie a výskyt reziduálních buněk byl sledován u pozitivních okrajů a vzdálenosti resekční linie od nádoru do 2 mm a 2−5 mm. Výsledky: Konzervativní výkon byl indikován 330x a reoperace byla u 78 pacientek pro nedostatečně volné okraje. Konzervativní výkon byl dokončen 311x a 19x byla definitivním výkonem mastektomie. Pozitivní resekční linie byla 10x. Vzdálenost do 2 mm byla 12x a vzdálenost 2–5 mm 56x. Z celkového počtu reresekcí byl nález maligních buněk v reexcidované tkáni nalezen 31x, což představuje 39,7 % všech pacientek. Reresekce pro pozitivní okraj, tzn. nádor v linii řezu, byla provedena 10x a u všech byl pozitivní nález, u vzdálenosti 2 mm byla reoperace 12x a 3x byl reresekát pozitivní, tzn. 25 %. U vzdálenosti řezu od nádoru 2−5 mm byla provedena reexcise 56x a u 18 pacientek byl pozitivní nález v reexcidované tkáni, tj. 32,1 % Závěr: U resekční linie „žádný nádor v dotyku s inkoustem“ musíme předpokládat ve třetině případů přítomnost reziduálních maligních buněk v prsu.

Introduction: Conservative procedures in early breast carcinoma are a safe alternative to mastectomy. The resection line is controversial, as well as the presence of residual malignant cells in the breast after excision and their influence on local recurrence. The aim of the study was to assess the presence of residual cells in re-excised tissues near positive resection lines, in the distance up to 2 mm, and 2–5 mm. The distance of more than 5 mm was evaluated as free margin. Method: All patients operated on in Atlas Hospital from 2004 to 2008 using conservative surgery were included in study. The resection line and the presence of residual malignant cells were followed in positive margins and in the distance of the resection line from the tumour up to 2 mm, and 2–5 mm. Results: The conservative procedure was indicated 330 times, and 78 patients were re-operated for insufficiently free margins. The conservative procedure was completed 311 times, and mastectomy was done as the final procedure in 19 cases. Positive resection line was found 10 times. Distance up to 2 mm occurred 12 times and 2−5 mm 56 times. In all re-operated patients, presence of malignant cells in the re-excised tissue was found 31 times (39.7%). Repeated surgery for positive line, i.e. tumour present in the resection line, was done 10 times while malignant cells were found in all patients; for the distance up 2 mm, repeated surgery was done 12 times and 3 cases were positive (25%). For the distance of 2–5 mm, repeated excision occurred 56 times and 18 cases were positive, i.e. 32.1%. Conclusion: For the resection line “no tumour in contact with ink”, presence of malignant cells in breast tissue must be expected in one third of the cases.

• MeSH
• konzervativní terapie MeSH
• lidé MeSH
• mastektomie metody   MeSH
• nádory prsu * chirurgie   terapie   MeSH
• nerandomizované kontrolované studie jako téma MeSH
• prospektivní studie MeSH
• prsy anatomie a histologie   patologie   MeSH
• recidiva MeSH
• resekční okraje MeSH
• reziduální nádor * chirurgie   MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH

CONTEXT: The question of the ability of frozen section analysis (FSA) to accurately detect malignant pathology intraoperatively has been discussed for many decades. OBJECTIVE: We aimed to conduct a systematic review and meta-analysis assessing the diagnostic estimates of FSA of the urethral and ureteral margins in patients treated with radical cystectomy (RC) for bladder cancer (BCa). EVIDENCE ACQUISITION: The MEDLINE and EMBASE databases were searched in February 2021 for studies analyzing the association between FSA and the final urethral and ureteral margin status in patients treated with RC for BCa. The primary endpoint was the value of pathologic detection of urethral and ureteral malignant involvement with FSA during RC compared with the final margin status. We included studies that provided true positive, true negative, false positive, and false negative values for FSA, which allowed us to calculate the diagnostic estimates. EVIDENCE SYNTHESIS: Fourteen studies, comprising 8208 patients, were included in the quantitative synthesis. Forest plots revealed that the pooled sensitivity and specificity for FSA of urethral margins during RC were 0.83 (95% confidence interval [CI] 0.38-0.97) and 0.95 (95% CI 0.91-0.97), respectively. While for the FSA of ureteral margins, the pooled sensitivity and specificity were 0.77 (95% CI 0.67-0.84) and 0.97 (95% CI 0.95-0.98), respectively. Calculated diagnostic odds ratios indicated high FSA effectiveness, and patients with a positive urethral or ureteral margin at final pathology are over 100 times more likely to have positive FSA than patients without margin involvement at final pathology. Area under the curves of 96.6% and 96.7% were reached for FSA detection of urethral and ureteral tumor involvement, respectively. CONCLUSIONS: Intraoperative FSA demonstrated high diagnostic performance in detecting both urethral and ureteral malignant involvement at the time of RC for BCa. FSA of both urethral and ureteral margins during RC is accurate enough to be of great value in the routine management of BCa patients treated with RC. While its specificity was great to guide intraoperative decision-making, its sensitivity remains suboptimal yet. PATIENT SUMMARY: We believe that the frozen section analysis of both urethral and ureteral margins during radical cystectomy should be considered more often in urologic practice, until quality of life-based cost-effectiveness studies can identify patients within each institution who are unlikely to benefit from it.

• MeSH
• cystektomie MeSH
• kvalita života MeSH
• lidé MeSH
• nádory močového měchýře * diagnóza   patologie   chirurgie   MeSH
• resekční okraje MeSH
• ureter * patologie   chirurgie   MeSH
• zmrazené řezy MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• systematický přehled MeSH

Úvod: Otázka dosažení radikálního cirkumferentního okraje u laparoskopických resekcí konečníku není stále uspokojivě objasněna. V prezentované práci jsme se soustředili na vy-hodnocení cirkumferentního resekčního okraje a kvality mezorektální excize u nádorů středního a dolního rekta a jejich porovnání mezi laparoskopickou a otevřenou technikou. Materiál a metodika: Vyhodnoceny byly výsledky resekčních výkonů pro karcinom středního a dolního rekta, které byly provedeny na chirurgické klinice Fakultní nemocnice v Hradci Králové v období od ledna 2011 do prosince 2012. Data byla sbírána prospektivně a ukládána do registru pro karcinom rekta. Sledované parametry byly věk, pohlaví, BMI, lokalizace a topografie nádoru, klinické stadium, neoadjuvantní chemoterapie a její odpověď, typ operačního výkonu, charakter distálního a cirkumferentního okraje, kvalita mezorektální excize, pT a pN. Výsledky: Celkem bylo v uvedeném období operováno 161 pacientů s karcinomem rekta. Po selekci vstoupilo do studie 94 pacientů. Laparoskopicky bylo provedeno 40 a klasicky 54 operací. Laparoskopicky bylo provedeno 33 (82,5 %) nízkých předních resekcí včetně čtyř intersfinkterických resekcí, abdominoperineálních amputací bylo v tomto souboru 6 (15 %) a 1 (2,5 %) Hartmannova operace. V souboru klasických výkonů bylo provedeno 26 (48,1 %) nízkých předních resekcí, 21 (38,9 %) amputačních výkonů a u sedmi (13 %) pacientů provedena Hartmannova resekce. Kompletní excize bylo dosaženo v 45 % v laparoskopické proti 46,3 % ve skupině klasické techniky, částečně kompletní excize byla provedena ve 22,5, resp. 11,1 %. Inkompletní excize byly popsány ve 30, respektive 38,9 %. U 3 pacientů nebyla kvalita mezorektální excize hodnocena. Rozdíly v kvalitě mezorektální excize nebyly statisticky významné. Pozitivní cirkumferentní okraj se vyskytl při laparoskopických operacích u 5 (12,5 %) pacientů, v případě klasické resekce u 15 (27,8 %) pacientů. Ani zde nebyly výsledky statisticky významné. V případě, že byl hodnocen selektovaný soubor pacientů s předoperační léčbou a byl porovnáván ypCRO mezi laparoskopickou a klasickou technikou, tak výsledek vyšel na hranici statistické významnosti (Fisher p=0,0556). Závěr: Naše studie prokázala srovnatelné výsledky mezi laparoskopickým a otevřeným přístupem při resekcích rekta. Výsledky dosažené zejména v kvalitě mezorektální excize a negativního CRO dokládají, že laparoskopický přístup je metodou bezpečnou a srovnatelnou s klasickou operační technikou v léčbě karcinomu rekta.

Introduction: The issue of achieving radical circumferential margin in laparoscopic rectal surgery has not yet been satisfactorily clarified. In this paper we have focused on circumferential margin assessment and the quality of the mesorectal excision, comparing laparoscopic and open resection for cancer of the middle and lower rectum. Material and Methods: The results of surgical procedures for middle and low rectal cancer were analysed. All the interventions were performed at the Department of Surgery, Teaching Hospital in Hradec Kralove, during the period from January 2011 to December 2012. The data were prospectively collected and entered in the Rectal Cancer Registry. Age, gender, BMI, tumour localisation and topography, the clinical stage, preoperative chemoradiotherapy and response to it, the type of surgery, distal and circumferential margin characteristics, mesorectal excision quality, pT and pN were compared for laparoscopic and open surgery. Results: A total of 161 patients were operated on for rectal cancer during the abovementioned period. 94 patients were included in the trial following selection. Laparoscopy was used in 40 patients and open surgery in 54 patients. Laparoscopic approach was performed in 33 (82.5%) low anterior resections (including four intersphincteric resections), 6 (15%) abdominoperineal amputations and 1 (2.5%) Hartmann’s procedure. Open surgery was used for 26 (48.1%) low anterior resections, 21 (38.9%) APR and 7 (13%) Hartmann’s procedures. Complete mesorectal excision was achieved in 45% of the laparoscopic resections vs. 46.3% of open resections. Nearly complete excision was performed in 22.5% and 11.1%, respectively. Finally, incomplete excision was described in 30% vs. 38.9%. No available data for TME was detected in three patients. The differences in TME were not statistically significant. Positive circumferential margin was found in 5 (12.5%) patients in the laparoscopy group; on the contrary, in the group undergoing open surgery, pCRO+ was found in 15 (27.8%) patients. Here, too, the results were not statistically significant. When patients without preoperative chemoradiotherapy were excluded, the relationship between ypCRM in the laparoscopy and open surgery group was on the border of statistical significance (Fischer=0.0556). Conclusion: As has been shown in our trial, the outcomes of laparoscopic and open approach in rectal cancer treatment are very similar. Particularly, mesorectal excision quality and negative CRM results have proven that the laparoscopic technique is safe and comparable to open surgery in rectal cancer treatment.

• Klíčová slova
• cirkumferentní okraj, totální mezorektální excize,
• MeSH
• chirurgie trávicího traktu * metody   MeSH
• dospělí MeSH
• klinické zkoušky jako téma MeSH
• laparoskopie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory rekta * chirurgie   MeSH
• rektum * anatomie a histologie   patologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• staging nádorů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

PURPOSE: While positive resection margin (RM) in women undergoing breast-conserving surgery (BCS) represents a clear indication for re-resection, there is no unequivocal recommendation regarding the extent of the clear RM. The aim of this study was to define the optimal extent of the RM and the risk factors for close or positive RM. METHODS: Patients scheduled for BCS had diagnosis confirmed before BCS (lumpectomy and quadrantectomy) by core biopsy. Sentinel lymph node biopsy followed BCS, and in case of positive findings axillary lymph node dissection followed. According to RM patients were categorized into 4 groups: 1) Patients with positive RM; 2) Clear RM < 2 mm; 3) Clear RM of 2-5 mm; and 4) RM > 5 mm. In the first 3 groups where re-resection was indicated, the presence of tumor cells in the re-resection specimen was determined. All patients were followed for local recurrence. RESULTS: 330 patients undergoing BCS were studied. Median follow up was 39.6 months (range 12-70). Lumpectomy was performed in 111 cases and quadrantectomy in 219. In 19 cases the final procedure was mastectomy due to the impossibility to achieve negative RM. In 78 cases re-resection followed the primary procedure due to close or positive RM. Clear RM was < 2 mm in 12 cases (15%), 2-5 mm in 56 (72%) and positive margin in 10 (13%). Positive re-resection specimen was detected in 31 cases (39.7%) (in 10 cases with positive RM after primary procedure, in 3 with negative margin < 2 mm and in 18 with 2-5 mm margin). The re-resection rate according to the location of the primary tumor was 77% (n=60) in the upper outer quadrant, 8% (n=6) in the lower outer quadrant, 6% (n=5) in the upper inner quadrant, 4% (n=3) in the lower inner quadrant, and 5% (n=4) in centrally located tumors. Multicentric/ multifocal tumor was diagnosed in 16 cases from which re-resection was indicated in 12 cases (75%). The number of re-resection according to tumor size was as follows: Tis 8 cases (30.7%), T1a none, T1b 14 (20.2%), T1c 34 (22.5%), T2 22 (28%). Re-resection was performed in 8 cases (31%) of ductal carcinoma in situ (DCIS), in 53 (22%) of ductal carcinoma, in 10 (37%) of lobular carcinoma, and in 7 (15%) of other histology. Five cases with local relapse were detected during follow up. CONCLUSION: The generally recommended clear RM of 1-5 mm is not sufficient because of the high number of positive specimens in the case of clear RM of 2-5 mm. The risk factors for close or positive RM are multicentric tumors and upper outer location of the primary tumor. Longer follow up will be needed to analyze local relapse rate according to RM status.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory prsu patologie   chirurgie   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• segmentální mastektomie metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The effect of human papillomavirus (HPV) vaccination on cervical intraepithelial neoplasia grade 2 or worse (CIN2+) recurrence with respect to cone margin positivity is unknown. Most studies assessed this effect beyond two months post-conisation. We aimed to determine both the duration and early onset of effect in women who had been prophylactically vaccinated or vaccinated after conisation, considering cone margin status. METHODS: This cohort study used data from one of the central laboratories in the Czech Republic, covering approximately 33% of women undergoing national cervical cancer screening. It included women treated for CIN2+ between 2010 and 2024 who had received either prophylactic HPV vaccination (available through the national immunisation program since 2011) or post-conisation vaccination (recommended by the Czech Gynaecological and Obstetrical Society since 2008). The vaccination effect was estimated using the incidence rate ratio (IRR) from a Poisson regression model, calculated as 100 × (1-IRR). FINDINGS: Of the 10,054 women enrolled, 919 were vaccinated after conisation, 502 prophylactically, and 169 had undetermined timing of vaccination. Throughout the follow-up period, CIN2+ recurrence was observed in 513 unvaccinated women, with a rate of 14·61 per 1000 person-years (py), in 14 prophylactically vaccinated women, with a rate of 5·84 (54% reduction; 95% confidence interval [CI]: 22-73%), and in 15 women vaccinated post-excision, with a rate of 3·37 (74% reduction; 95% CI: 57-85%). The high recurrence rate of 58·59 per 1000 py within six months of conisation was reduced by 80% (95% CI: 19-95%) with prophylactic vaccination and by 89% (95% CI: 57-97%) with incomplete post-excision vaccination. Among a total of 1771 women with a positive cone margin, recurrence was identified in 272 of 1568 unvaccinated women, corresponding to a recurrence rate of 51·62 per 1000 py. A reduction was observed in 84 prophylactically vaccinated and in 119 women vaccinated post-excision, with only 6 recurrence cases documented in each group. This corresponded to recurrence rates of 14·94 (62% reduction; 95% CI: 14-83%) and 9·78 per 1000 py (79% reduction; 95% CI: 52-90%), respectively. INTERPRETATION: Regardless of timing, HPV vaccination has a beneficial long-term effect in lowering the risk of CIN2+ recurrence. Despite the greater reduction in relapse achieved by post-excision vaccination, the difference compared with the prophylactic one was not statistically significant. The most pronounced benefit was observed within the first six months post-conisation, particularly in women with a positive cone margin. FUNDING: Cooperatio 31 fund, Health Sciences, Charles University, Prague, Czech Republic.

• Publikační typ
• časopisecké články MeSH

Značení resekčních okrajů vzorků tkáně stříbřením přináší oproti běžnému značení tkáně tuší ně- které výhody: tkáň při přikrajování zachovává původní barvu, zabarvení je stálé, nedochází ke znečištění řezné plochy ani tekutin při sycení tkání parafinem, značení je dobře viditelné na tká- ňových řezech. Pro značení používáme krátké ponoření tkáně do roztoku 10% dusičnanu stříbrného AgNO 3 s přídavkem kyseliny dusičné; po nakrájení jsou tkáňové řezy vyvolány běžnou černobílou fotografic- kou vývojkou.

Marking excision margins of surgical specimens by silver impregnation has several advantages over commonly used Indian ink: during the slicing the tissue preserves its natural color, the staining is permanent, and the pigment does not smudge over cutting surfaces. The pigment is clearly visible in tissue sections. The tissue specimen is shortly dipped into a 10% water solution of argent nitrate (AgNO3withHNO3). After slicing, the tissue specimens are developed in common black & white developer for several seconds and paraffin processed as usual. The method is suitable for formaldehyde fixed as well as fresh tissue specimens.

• MeSH
• barvení stříbrem metody   využití   MeSH
• biopsie metody   MeSH
• finanční podpora výzkumu jako téma MeSH
• lidé MeSH
• odběr biologického vzorku MeSH
• Check Tag
• lidé MeSH

The individual clinical significance of a positive surgical margin (PSM) after radical prostatectomy has remained controversial. Studies have suggested that the Gleason grade (GG) at the PSM could improve predictive accuracy and decision making. Our objective was to systematically review the reported data to determine the effect of the GG at the PSM on the prognosis after radical prostatectomy. A systematic review was conducted by searching MEDLINE/PubMed for studies reported by June 2019 in accordance with the Preferred Reporting Items for Systematic Review statement. The keywords used included prostate cancer, radical prostatectomy, positive surgical margin, Gleason score, and/or Gleason grade. After a systematic literature review, 10 studies were included, comprising 14,108 patients, of whom 2454 (17.4%) had a PSM and 428 (14%) eventually experienced biochemical recurrence (BCR) within a median follow-up of 18 to 156 months. Data on neoadjuvant or adjuvant therapy were not estimable. In a meta-analysis, GG4 at PSM was significantly associated with BCR compared with GG3 (pooled hazard ratio, 1.87; 95% confidence interval, 1.53-2.28; z = 6.16). The Cochrane Q test (χ2 = 5.88; P = .318) and I2 test (I2 = 15.0%) showed that no significant heterogeneity was present. GG4 at a PSM is a feature of biologically and clinically aggressive prostate cancer that is associated with a significant increase risk of BCR. GG at PSM should be recorded in each pathological report. Given this adverse prognostic value patients with GG4 at the PSM should be considered for multimodal therapy such as radiotherapy.

• MeSH
• lidé MeSH
• lokální recidiva nádoru MeSH
• nádory prostaty * chirurgie   MeSH
• prognóza MeSH
• prostatektomie MeSH
• prostatický specifický antigen MeSH
• resekční okraje * MeSH
• stupeň nádoru MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• systematický přehled MeSH

Úvod: V posledných rokoch získalo hodnotenie cirkumferenčného resekčného okraja (CRM) enormnú dôležitosť v manažmente pacientov s karcinómom rekta, a to nielen v predikcii prognózy pacientov, ale aj v stanovovaní presného stagingu ochorenia, v indikáciách multimodálnej liečby a v hodnotení kvality poskytovanej terapie. Metodika: Autori ponúkajú prehľadový článok obsahujúci definíciu cirkumferenčného (radiálneho, laterálneho) resekčného okraja, techniku stanovovania CRM, vplyv CRM na prognózu a kvalitu poskytovanej terapie. Osobitný dôraz je kladený na hodnotenie CRM v kontexte multidisciplinárneho teamu. CRM musí totiž brať do úvahy rádiológ pri stanovovaní stagingu ochorenia, chirurg v priebehu operácie, patológ v čase dôsledného makroskopického a histopatologického hodnotenia preparátu a onkológ pri rozhodovaní o podávaní neoadjuvantnej/adjuvantnej terapie. Závěr: Cirkumferenčný resekčný okraj predstavuje v súčasnosti základný aspekt v modernom prístupe k pacientom s karcinómom rekta. Zavedenie CRM hodnotenia do klinickej praxe malo za dôsledok presnejší staging ochorenia, relevantnejšie stanovovanie indikácií multimodálnej liečby, precíznejšiu operačnú techniku (TME), zvýšenie počtu sfinkter – zachovávajúcich operácií, zníženie počtu lokálnych recidív ochorenia a zlepšenie prežívania pacientov s karcinómom rekta.

Introduction: In the last decades, the assessment of circumferential resection margin (CRM) has gained enormous importance in the management of patients with rectal carcinoma, not only in predicting the prognosis, but also in precise cancer staging, in multimodal treatment indications and in quality assessment of provided care. Methods: The authors present a review article containing CRM definition, describing the technique of CRM assessment, the effect of CRM status on the prognosis and quality of provided therapy. CRM assessment in the context of a multidisciplinary team is especially emphasised. The aspect of CRM has to be considered by the radiologist during cancer staging, the surgeon in the course of the operation, the pathologist during precise macroscopic and histopathological specimen evaluation, and the oncologist when deciding on neoadjuvant/adjuvant therapy administration. Conclusion: CRM nowadays represents a fundamental aspect in modern treatment of patients with rectal carcinoma. The introduction of CRM assessment into clinical practice has lead to more precise staging, better multimodal therapy indications, more precise surgical technique (total mesorectal excision), an increased rate of sphincter-saving resections, lowered local recurrence rates and improved patient survival.

• Klíčová slova
• M.E.R.C.U.R.Y. kritéria, totální mesorektální excise, cirkumferenční resekční okraj,
• MeSH
• chirurgie trávicího traktu metody   MeSH
• chirurgie MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• nádory rekta diagnóza   chirurgie   klasifikace   patologie   MeSH
• patologie MeSH
• prognóza MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• staging nádorů MeSH
• Check Tag
• lidé MeSH