Frozen section examination may facilitate reconstructive surgery for mid and low rectal cancer

Khoury, Wisam; Abboud, Wisam; Hershkovitz, Dov; Duek, Simon D.

doi:10.1002/jso.23758

Cited by 13 publications

(5 citation statements)

References 26 publications

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“…In patients with upper rectal and rectosigmoid tumors, the intraoperative assessment of margins with frozen section is not routinely necessary as adequate margins can be achieved while more easily restoring intestinal continuity. Frozen section has a sensitivity and specificity of 83% and 98%, respectively, for rectal cancer and a frozen section negative margin of >5 mm correlates well with negative margin on final surgical pathology . Newer technology such as multiphoton microscopy is being evaluated as a real time assessment of surgical margins without the need for tissue processing .…”

Section: Intraoperative Assessment Of Marginsmentioning

confidence: 99%

Importance of surgical margins in rectal cancer

Krishnamurty

Wise

2016

Journal of Surgical Oncology

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Distal resection margin (DRM) and circumferential resection margin (CRM) are two important considerations in rectal cancer management. Although guidelines recommend a 2 cm DRM, studies have shown that a shorter DRM is adequate, especially in patients receiving neoadjuvant chemoradiation. Standardization of total mesorectal excision has greatly improved quality of CRM. Although more patients are undergoing sphincter-saving procedures, abdominoperineal resection is indicated for very distal tumors, and pelvic exenteration is often necessary for tumors involving pelvic organs.

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Section: Intraoperative Assessment Of Marginsmentioning

confidence: 99%

Importance of surgical margins in rectal cancer

Krishnamurty

Wise

2016

Journal of Surgical Oncology

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“…It has been suggested that intraoperative frozen section of surgical specimens may provide an accurate diagnosis to guide the selection of surgical procedures (18). In the current case, histopathological examination of the surgical specimen was performed postoperatively, therefore further strategic planning of the surgical operation and intraoperative management of the patient was straightforward.…”

Section: Discussionmentioning

confidence: 90%

Laparoscopic resection of a sigmoid colon lipoma in a young female patient: A case report and review of the literature

et al. 2017

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Abstract. Lipomas of the sigmoid colon are rare entities. The present case describes a 27-year-old Caucasian woman who underwent a laparoscopic sigmoidectomy following the detection of a giant lipoma. The young patient was referred to the Emergency Department of the University Hospital of Heraklion (Crete, Greece) in May 2013 after experiencing intermittent abdominal cramping during defecation, and altering episodes of diarrhea and constipation. In addition, the patient described the protrusion of a solid tissue mass shaped like a 'champagne bottle cork' from the anus following defecation. These symptoms had been present for 1 month prior to referral. Physical examination was unremarkable. An urgent colonoscopy revealed a polypoid lesion measuring 2.5 cm in diameter in the sigmoid colon, which was located ~12 cm above the anal ring, with a smooth surface and tissue fragility. Tissue samples were obtained and sent for histopathological analysis. Preoperative contrast-enhanced computed tomography was performed urgently and confirmed the presence of a solid mass in the sigmoid colon without enlargement of regional lymph nodes. Following adequate preparation, the patient underwent a laparoscopic sigmoidectomy with intracorporeal termino-terminal colorectal anastomosis, with the use of a circular stapler. The patient had a positive post-operative outcome without complications and was discharged on day 4 post-surgery in an optimal condition. Histopathological examination of the surgical specimen demonstrated a pedunculated lipoma shaped like a 'champagne bottle cork'. The tumor consisted of mature adipose cells. The overlying colonic mucosa showed hyperplastic crypts with regenerative changes. In the lamina propria mild inflammatory infiltration was observed. At 2 years post-surgery, the patient remains asymptomatic without any clinical evidence of recurrence.

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“…Several methods have been developed for intra-operative colorectal tumor localization, such as barium enemas [4,5], frozen sections [6,7], pre-operative endoscopic tattooing or clip placement [8][9][10][11][12][13][14], intra-operative endoscopy [15], fluorescence guidance [16][17][18], and surgical navigation technology [19,20]. However, these techniques all have certain drawbacks, including radiation exposure, a long duration, non-optimal accuracy, complexity, and the need for special instruments or technical support.…”

Section: Introductionmentioning

confidence: 99%

Tumor Segmentation in Colorectal Ultrasound Images Using an Ensemble Transfer Learning Model: Towards Intra-Operative Margin Assessment

Geldof,

Pruijssers,

Jong

et al. 2023

Diagnostics

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Tumor boundary identification during colorectal cancer surgery can be challenging, and incomplete tumor removal occurs in approximately 10% of the patients operated for advanced rectal cancer. In this paper, a deep learning framework for automatic tumor segmentation in colorectal ultrasound images was developed, to provide real-time guidance on resection margins using intra-operative ultrasound. A colorectal ultrasound dataset was acquired consisting of 179 images from 74 patients, with ground truth tumor annotations based on histopathology results. To address data scarcity, transfer learning techniques were used to optimize models pre-trained on breast ultrasound data for colorectal ultrasound data. A new custom gradient-based loss function (GWDice) was developed, which emphasizes the clinically relevant top margin of the tumor while training the networks. Lastly, ensemble learning methods were applied to combine tumor segmentation predictions of multiple individual models and further improve the overall tumor segmentation performance. Transfer learning outperformed training from scratch, with an average Dice coefficient over all individual networks of 0.78 compared to 0.68. The new GWDice loss function clearly decreased the average tumor margin prediction error from 1.08 mm to 0.92 mm, without compromising the segmentation of the overall tumor contour. Ensemble learning further improved the Dice coefficient to 0.84 and the tumor margin prediction error to 0.67 mm. Using transfer and ensemble learning strategies, good tumor segmentation performance was achieved despite the relatively small dataset. The developed US segmentation model may contribute to more accurate colorectal tumor resections by providing real-time intra-operative feedback on tumor margins.

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Frozen section examination may facilitate reconstructive surgery for mid and low rectal cancer

Abstract: FS examination may help determine free distal margin and consequently, in selected cases, may facilitate a restorative procedure in patients with low rectal cancer.

Cited by 13 publications

References 26 publications

Importance of surgical margins in rectal cancer

Importance of surgical margins in rectal cancer

Laparoscopic resection of a sigmoid colon lipoma in a young female patient: A case report and review of the literature

Tumor Segmentation in Colorectal Ultrasound Images Using an Ensemble Transfer Learning Model: Towards Intra-Operative Margin Assessment

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