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Tumors were left to grow until they reached an average of 1.5 cm at their largest dimension at which time they were resected within their pseudo-capsule, thus mimicking a complete macroscopic resection with positive microscopic margins.
c Macroscopic resection specimen.
First, it has to achieve a completely clear macroscopic resection margin [6], and second, a sufficient volume of functioning liver has to be spared.
The aim of surgery with curative intent for MPM is to obtain macroscopic resection, but which surgical procedure, EPP or P/D, is more beneficial remains controversial [1, 4].
Complete macroscopic resection was performed in 65 of the 70 patients (93%) who received capecitabine CRT.
Complete macroscopic resection was achieved in 71.4% (110 of 154) of the patients.
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In total, 28 of 31 (90%) patients underwent surgical resection and 27 of 31 (87%) had complete macroscopic resections.
Interestingly, in recent meta-analysis of three randomised trials the rate of complete macroscopic resections of liver metastases was 12.5% in men using chronomodulated delivery vs 7.8 8.5% in men using conventional delivery, or in women on either schedule (Levi et al, 2009).
Resection into the circumference of macroscopic (R2 resection) or microscopic tumour (R1 resection) or into the depth of the tumour can of course contribute to disseminated cells in the peritoneal cavity as well as is in cases with tumour penetration of serosa or in overt peritoneal carcinomatosis.
The main aim of treating such patients is to achieve a macroscopic complete resection with histologically confirmed clear (uninvolved) resection margins.
Macroscopic complete resection was achieved with extended P/D with combined resection of involved diaphragm and pericardium.
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