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In canine mast cell tumours (MCTs), distant metastasis (DM) occurs infrequently. However, high-risk MCTs or tumours with certain negative prognostic factors (NPFs) are those more prone to develop metastatic disease. Accordingly, a thorough workup might not be necessary for MCTs lacking NPFs. The objective of this study was to evaluate the rate of DM and, therefore, the benefit of extensive staging in dogs presenting with and without NPFs. Furthermore, the association between the selected NPFs and DM was assessed, and factors that may have influenced outcome were evaluated. Dogs presenting with at least one NPF (Patnaik III/Kiupel high-grade, LN metastasis, rapid growth, ulceration, recurrence, high-risk location) were defined as high-risk and without as low-risk MCTs. Ninety-nine dogs were included, with 49% of MCTs in the high-risk and 51% in the low-risk group. All seven dogs with DM were identified in the high-risk group; 43% were Patnaik III/Kiupel high-grade tumours. The median survival time (MST) for this subgroup was 84 days. Patnaik III/Kiupel high-grade and rapid growth were NPFs significantly associated with DM at staging. Furthermore, a significant difference (p < .001) in MST was demonstrated between the high-risk and low-risk groups (899 days vs. not reached). NPFs significantly associated with outcome were rapid growth, presence of DM at staging, and surgical tumour excision. These results indicate that extensive staging in the absence of NPFs does not seem to be beneficial. On the other hand, by using the selected NPFs, a subset of MCTs prone to DM can be identified.

Objectives Although the reliability of frozen sections for the intraoperative assessment of complete tumour excision has been established, the best location for collection and the impact of the type of sampling are still debated. We retrospectively investigated the reliability of frozen sections when collected from the surgical bed as tissue strips representative of the whole superficial margin and as a bowl of tissue underlying the resection site for deep margin, and the possibility of relying on frozen section negativity to consider resections complete. Materials and methods Frozen section reliability was calculated by comparing histology before and after formalin embedding and then categorised by sampling type, in 182 patients undergoing transoral resection of oral cancer. Results Comparing frozen and permanent histology, sensitivity, specificity and accuracy were 69%, 98% and 96%, respectively; categorisation by sampling type failed to produce statistically significant differences. Based on frozen section negativity after formalin embedding, complete resections were obtained in 91.7% of patients with multiple-strip and bowl frozen sections. Conclusion Frozen sections collected as tissue strips and bowl are as reliable as point sampling in the intraoperative guidance of surgical resections. They effectively provide for margin enlargement, thereby increasing the surgeon's confidence that negative margins are clear.

Purpose Overall local recurrence of oral squamous cell carcinoma (OSCC) is estimated at 20%. Incomplete primary tumour excision contributes to localised postsurgical recurrence of OSCC. The purpose of this study was to report on patient outcomes following resection of OSCC using Narrow Band Imaging (NBI). Materials and methods Patients with OSCC requiring resection were visualised under conventional white light (WL) then NBI using an Olympus NBI ENF-VQ nasendoscope with CLV-180 light source and processor (Olympus Medical Systems, Tokyo, Japan). OSCC tissue was resected to the NBI-defined surgical margins, and patients followed for a minimum of 5 years postsurgery to assess local recurrence rate (LRR) and disease-free survival (DFS). Results Of the 20 patients recruited for this study, one patient (5%) declined follow-up. At the latest follow-up period (up to 7 years postsurgery), 14 of 19 patients (73.68%) were alive with no recurrence. Two patients (10.53%) had died from metastatic disease with no local recurrence, one patient (5.26%) had died from disease with local recurrence, and two patients (10.53%) had died disease-free from other causes. In total, 16 of 19 patients (84.21%) who were followed for a minimum of 5 years were still alive and had not developed local recurrence. Only one patient developed local recurrence. Five-year DFS was 84.21% and LRR was 5.26%. Conclusion Resection to NBI-defined margins improves survival rates and decreases recurrence rates of OSCC compared to traditional methods and should be adopted as the new gold standard for determining mucosal surgical margins for treatment of oral cavity cancer. These promising results have set the scene for a multicentred randomised controlled trial comparing NBI to WL currently underway.

Various skin tumours such as squamous cell carcinoma and extramammary Paget's disease can occur in the vulval area, and reconstruction of the vulval area can be a very challenging task. A retrospective analysis of vulvar reconstruction using the new method 'internal pudendal perforator artery-based gull wing flap' was performed from April 2012 to December 2013. A perforator vessel from the internal pudendal artery was detected with a portable Doppler and marked, and this was the pivot point around which the flap was rotated. The flap was rotated by more than 150°-180° internally, and the labium and the external wall of the vagina were reconstructed with sufficient volume. Anatomical and aesthetic reconstruction of the labium and the vagina was performed without serious complications. Functional and aesthetic vulvar reconstruction can be achieved by using a flap that provides sufficient volume of the labium. Our new technique, the 'internal pudendal perforator artery-based gull wing flap', is good and it can be used to reconstruct a functional and aesthetically acceptable vulvovagina for large defect wound after tumour excision.

What's known on the subject? and What does the study add? The European Association of Urology (EAU) guidelines recommend an inguinal lymph node dissection (ILND) in patients with T1G2-3 squamous cell carcinoma of the penis (SCCP). To date, only four series reported the rates of cancer-specific mortality (CSM) after primary tumor excision (PTE) without an ILND in patients with T1 clinically node-negative (cN0) SCCP. We examined CSM rates in cN0 patients with T1G1-3 SCCP, in whom an ILND was not performed, relying on competing-risks analyses. OBJECTIVE • To quantify and compare cancer-specific mortality (CSM) and other-cause mortality (OCM) in individuals with stage T1G1–3 clinically node-negative (cN0) squamous cell carcinoma of the penis (SCCP) since there is no consensus regarding the need for an inguinal lymph node dissection (ILND) in patients with T1G2–3 cN0 SCCP. METHODS • Relying on the Surveillance, Epidemiology and End Results database, we identified 655 patients diagnosed with primary SCCP between 1988 and 2006. • Cumulative incidence plots were used to graphically depict the effect of CSM relative to OCM. • Competing-risks regression analyses were used to quantify the risk of CSM or OCM after adjusting for age, race, tumour grade and surgery type. RESULTS • The 5-year CSM rates after a primary tumour excision without ILND were 2.6%, 10.0% and 15.9% in patients with respectively T1G1, T1G2 and T1G3 cN0 SCCP. • The 5-year OCM rates were 29.5%, 27.3% and 29.3% in patients with respectively T1G1, T1G2 and T1G3. • Age failed to provide additional stratification. CONCLUSIONS • The CSM rate was highest in T1G3 patients and appears to justify ILND. • Conversely, the CSM rate was lowest in T1G1 patients, which justifies active surveillance in this patient subset. • A moderate CSM rate at 5 years was recorded for T1G2 patients, which brings into question the benefits of ILND.

Objectives To evaluate the efficacy of a self-retaining barbed suture (SRBS) in achieving a secure and haemostatic renorrhaphy during laparoscopic partial nephrectomy (LPN). To compare perioperative outcomes for LPN with SRBS with those for LPN with conventional polyglactin suture, with specific attention to warm ischaemia time, blood loss and need for postoperative bleeding interventions. Patients and methods Patients who underwent LPN between June 2007 and October 2010 were identified through an Institutional Review Board approved registry of oncological patients. Before July 2009, parenchymal repair after tumour excision was performed using absorbable polyglactin suture (Group 1), and subsequently, using SRBS (Group 2). Demographic, clinical, intraoperative and postoperative outcomes were compared for each group. Results LPN was performed in 49 patients in Group 1 and 29 in Group 2. Baseline demographic and clinical features, estimated blood loss, and transfusion and embolization rates were statistically similar for the cohorts. Mean warm ischaemia time (±SD) was significantly shorter for the SRBS group (26.4 ± 8.3 vs 32.8 ± 7.9; P= 0.0013). Bleeding requiring intervention (open conversion or transfusion ± embolization) was more common for Group 1 (9/49, 18.4% vs 1/29, 3.4%; P= 0.06). Conclusions The use of SRBS for parenchymal repair during LPN in humans is safe and is associated with a significant reduction in warm ischaemia time. SRBS use during LPN may also reduce rates of clinically significant bleeding. Prospective, larger studies to confirm the value of SRBS use in minimally invasive partial nephrectomy are warranted.

The two-year prognosis for malignant mammary tumours seen in 175 bitches in the Tokyo metropolitan area was assessed based on the extent of mastectomy and on whether an ovariectomy was carried out at the time of mastectomy. The prognosis for the bitches was not influenced by the excision size of the affected mammary glands. Ovariectomy had no effect on the two-year survival rate of the dogs that underwent the tumour excision. There was no significant difference in the two-year survival rate between the dogs ovariectomised prior to mastectomy and those ovariectomised at the time of mastectomy. These results suggest that ovariectomy at the time of mastectomy has no effect on the prognosis in dogs with established neoplasms of the mammary gland.

The healing of skin wounds is markedly influenced by their relationship to the tensional forces in the skin. Directional variations in skin extensibility which give rise to the cleavage line phenomenon and the skin tension lines are easily visualized by a recently developed skin marking technique. This technique makes it possible to plan accurately the optimum line of excision of skin tumours, including malignant melanomata, so as to allow primary linear wound closure without the necessity of undermining or grafting. The technique is particularly applicable to the excision of tumours of the back and limbs, and in addition, provides a warning if the local skin tensional state makes primary closure hazardous.

Reports of three cases of large oral fistula following tumour excision are presented. The repairs utilized deltopectoral, forehead, and scalp flaps. Technical points discussed include the de-epithelialization of folded flaps, the preservation of vermilion, the placement of immediate fascial slings and the use of island flaps.

In a longitudinal study performed before and after surgical resection of a chemically-induced, transplanted rat tumour we found that a monocytosis- and tumour-induced anti-inflammatory effect directed against macrophages was promptly corrected by tumour excision but recurred with metastasis. These observations indicate that the monocyte abnormalities are acquired and related to cancer progression. The anti-inflammatory effect required relatively large primary or metastatic tumour burdens. Our findings support the clinical impression that monocyte abnormalities are associated with a poor prognosis.