Читать книгу Veterinary Surgical Oncology - Группа авторов - Страница 104

After local tumor resection, the surgeon has an important role communicating with the pathologist to help identify the specimen margins that are most likely to be close or incomplete. This can be achieved by providing detailed information on the pathology submission form, including pertinent clinical history as well as attempting to maintain normal tissue architecture and using ink and/or sutures to orient the tissues.

The surgeon is responsible for interpreting the pathology report in the context of the surgery performed. The pathology report should contain three important pieces of information for the surgeon that will help to dictate whether adjuvant therapy is required: the histologic diagnosis, the tumor grade if appropriate, and the adequacy of surgical margins. If surgical margins are incomplete, the entire surgical scar is assumed to be contaminated with tumor cells and larger surgery or adjunctive treatments such as radiation therapy or chemotherapy are indicated.

Because the entire surgical scar is assumed to be contaminated with tumor cells when performing the second surgery where the goal is to remove the residual tumor cells left behind, the entire surgical scar needs to be removed. In one study evaluating the second surgery for soft tissue sarcomas in dogs (Bacon et al. 2007), it was suggested that if wide excision of the previous scar was not possible (because of anatomic location for example), excision of the scar with narrow margins appeared to be beneficial. However, it is not just the scar that is contaminated but the entire previous surgical bed. Therefore, excising the entire surgical bed should be the goal of the second surgery. One study concluded that the extent of the surgical bed is, as expected, proportional to the extent of the first surgery. The mean maximum lateral extension was 6, 14, 18, and 26 mm for 2‐, 4‐, 6‐, and 8‐cm skin defects, respectively. Even so, removing a scar with 3 cm margins around it can lead to an incomplete excision of the surgical bed in some cases when the skin defect was more than 4 cm (Cunningham and Skinner 2020).