title: Clinical implications of positive margins following non-small cell lung cancer surgery.
abstract: Positive margins following pulmonary resection of non-small cell lung cancer (NSCLC) occur in approximately 5-15% of patients undergoing a curative procedure. The presence of positive margins negatively impacts long-term outcomes by setting the stage for local and potentially distant disease recurrence. Despite major clinical ramifications, there are very few dedicated reports that examine the implications of positive margins following surgery for NSCLC. Furthermore, published series are typically retrospective studies from single institutions. In this review we analyze published data with special consideration of four pertinent questions: (i) what are the long term outcomes of a positive margin following pulmonary resection?, (ii) is intraoperative margin assessment by frozen section reliable?, (iii) what is the optimal distance of the tumor margin to the surgical margin?, and (iv) should adjuvant chemotherapy and/or radiation therapy be used in the setting of a positive surgical margin?
authors.affiliation: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jarrod D
authors.initials: JD
authors.lastname: Predina
authors.affiliation: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jane
authors.initials: J
authors.lastname: Keating
authors.affiliation: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Neil
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Sarah
authors.initials: S
authors.lastname: Nims
authors.affiliation: Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Sunil
authors.initials: S
authors.lastname: Singhal
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D005629:Frozen Sections; D006801:Humans; D007432:Intraoperative Period; D008175:Lung Neoplasms / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery* / Q000628:therapy; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018365:Neoplasm, Residual / Q000517:prevention & control; D011013:Pneumonectomy / Q000592:standards*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D015203:Reproducibility of Results
keywords: local recurrence; non-small cell lung cancer (NSCLC); positive margin