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Abstrak :
Latar Belakang: Soft tissue sarcoma menjadi salah satu penyebab kematian karena angka kelangsungan hidup yang rendah. Tatalaksana utamanya merupakan pembedahan, dengan margin reseksi yang seringkali ditentukan sesuai opini atau pengalaman ahli bedah yang bersangkutan. Belum ada pedoman yang jelas dalam penggunaan surgical margin. Oleh karena itu, disusun telaah sistematis untuk menguraikan perbedaan luaran terhadap margin reseksi sehingga dapat diketahui manakah yang memberikan hasil terbaik untuk dijadikan pedoman tatalaksana di Indonesia. Metode: Penelitian merupakaan telaah sistematis yang menelaah studi tentang pengaruh dari surgical margin terhadap rekurensi lokal dan kesintasan pasien dengan soft tissue sarcoma. Hasil: Hasil yang didapatkan adalah pada analisis univariat, didapatkan pembedahan dengan margin reseksi R0 memberikan angka rekurensi lokal yang lebih rendah dan kesintasan yang lebih tinggi daripada R1 secara independen. Hasil analisis multivariat menunjukkan bahwa kemungkinan kelompok pasien dengan margin reseksi R1 mengalami rekurensi lokal dan kematian lebih besar daripada R0. Kesimpulan: Margin reseksi R0 dari klasifikasi R+1 UICC memberikan luaran yang lebih baik dari R1. ......Background: Soft tissue sarcoma is one of the common causes of death due to the relatively low survival rate, especially among adults. Surgery is the main treatment, whereas the surgical margin is often decided based on the opinions or experience of the surgeons. Therefore, we reviewed studies to learn more about the outcome of surgical margin to know of which giving the best and can be adopted as the guideline for management in Indonesia. Methods: This is a systematic review which reviewed studies about the influence of surgical margin towards local reccurence and survival in STS patients. Results: Based on univariate analysis, surgical margin R0 shows lower local reccurence rate and higher survival rate rather than R1. Based on multivariate analysis, patients R1 group is more likely to experience local recurrence and death. Conclusion: Surgical margin R0 based on R+1 classification UICC shows better outcomes than R1

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ABSTRAK
Latar Belakang: NAC neoadjuvant chemotherapy secara umum telah digunakan di LABC locally advanced breast cancer untuk mengurangi ukuran tumor dan membuat tumor tersebut bisa untuk dioperasi. Meskipun ukuran tumor telah berkurang, masih diperdebatkan batas pembedahan pasca NAC untuk LABC dengan karsinoma mastitis, ulkus payudara, dan fitur agresif lainnya bebas dari tumor karena kemoterapi tidak bisa membunuh 100 dari sel-sel tumor.Metode: Desain penelitian adalah studi potong lintang. Sampel diambil dari semua pasien dengan LABC yang datang ke klinik onkologi rawat jalan dari RS Cipto Mangunkusumo dan ditato untuk batas pembedahan berdasarkan ukuran tumor sebelum NAC. Penelitian ini dilakukan untuk menentukan batas pembedahan yang benar di LABC setelah NAC.Hasil: Dari total 85 pasien, 42 pasien termasuk dalam studi dan 30 pasien masih menjalani pemberian NAC. Umur pasien berkisar antara 27-70 tahun dengan frekuensi tertinggi adalah 40-50 tahun 47,6 . Frekuensi kasus tersering adalah pasien dengan stadium IIIB 92,9 , grade 2 66,7 , histopalogi karsinoma duktal invasif 92,8 hasil IHK imunohistokimia over-ekspresi HER2 42,8 , volume tumor sebelum NAC > 100cc 85,8 dan volume tumor setelah NAC 50-100cc 57,2 . Regimen kemoterapi yang banyak digunakan CAF 76,1 dengan respon parsial 95,2 .Kesimpulan: Batas sayatan kulit berdasarkan ukuran tumor pasca NAC dapat menjadi acuan untuk operasi, namun pada dasar sayatan operasi masih perlu dilakukan frozen section untuk memastikan bebas tumor atau tidak. Seorang ahli bedah juga harus lebih berhati-hati dalam menentukan batas sayatan operasi pada kasus mastitis karsinomatosis, ulkus payudara yang besar dan tumor yang terletak di medial payudara dimana pada kondisi ini batas sayatan operasi dapat beresiko tidak bebas tumor.

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ABSTRACT
Introduction There is limited evidence regarding the effectivness of neoadjuvant chemotherapy NAC to improve surgical margins for locally advanced breast cancer LABC patients. In this study, NAC was used to reduce tumor size to improve operability and reduce surgical margins, with confirmation of tumor free areas provided by post operative histopathology. The reduction of surgical margins has the potential to reduce the need for extensive surgery and the risk of complications in LABC patients.Method The study participants were patients diagnosed with LABC in Ciptomangunkusumo Hospital Jakarta and Awal Bros Bekasi Hospital Bekasi between 2014 and 2015. Patients underwent NAC, and those with partial or complete response were sent for surgery. Tumor excision was done according to the pre NAC surgical margin, which was marked by tattoo. Histopathology then checked for tumor cells in the surgical margins based on breast tumor size of pre and post NAC. Data was analyzed with SPSS version 20 with numerous statistical tests. Cross tabulation analyses were done to examine the characteristics of the study participants. McNemar test was used to determine and compare the pre and post NAC surgical margins.Results Out of 42 patients, 38 were observed to have tumor free surgical margins in both pre and post NAC. Of the remaining four patients, three patients had tumor cells in both surgical margins, and one patient had a tumor free pre NAC but positive tumor cells post NAC. McNemar analysis suggests no significant difference p 1,000 in the two surgical margins evaluated. Based on Wilson score analysis, agreement of negative result of surgical margin in pre NAC compare to post NAC is 97.3 CI 86,18 99.52 . Mean while, agreement of positive tumor cell in pre NAC to post NAC surgical margin is 100 CI 90.36 100 .Conclusion Surgical margins in the skin based on the post NAC tumor size can be used as a guide for surgery, but not in the tumor base. If the surgical margin of tumor base is ambiguos, frozen section can be performed to confirm tumor free in the tumor base. This will reduce the risk of residual tumor cells in surgical margins.

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ABSTRACT
Stage I non-small cell lung cancer (NSCLC) is a localized disease without metastasis; therefore, it can be treated effectively with local therapies. Pulmonary resection is the most frequent treatment, performed as pulmonary wedge resection, segmentectomy, lobectomy, or pneumonectomy. Some retrospective clinical studies of pulmonary wedge resection suggest that its outcome may be inferior to that of anatomical pulmonary resection, whereas other recent studies, which assess surgical margin status, leveled acceptable outcomes. Since the outcome of pulmonary wedge resection for lung cancer may depend on tumor size, distance from the surgical margin to the tumor, tumor size/margin distance ratio, and margin cytology results, a prospective study assessing these parameters is ongoing. This will allow us to identify the clinical implications of these factors and predict which patients are likely to have a good outcome.