What is meant by ‘surgical margin’?
During cancer surgery, the aim is not only to remove the visible tumour, but also a strip of healthy tissue surrounding it.
This ring of tissue is known as the surgical margin. From a pathological point of view, this tissue is analysed in the laboratory to check for residual tumour cells.
What does it mean when they are ‘free’?
When the margins are free, it means that no cancer cells have been found when the edge of the removed tissue is analysed. This indicates that the resection has been complete. Conversely:
- Positive or compromised margin: tumour cells are detected at the edge, suggesting that part of the tumour may have been left inside the body.
- Close margin: the cells are very close to the edge but do not touch it; this can also lead to clinical uncertainty.
Why is it important to have clear surgical margins?
Relationship with local tumour control
Having negative or clear margins reduces the likelihood of the tumour reappearing in the same area (local recurrence). In many types of cancer, this is directly associated with improved survival rates and disease control.
Role of the pathology report
The margins are analysed after the operation in a pathology report. This document is essential to confirm that the surgery has achieved its oncological goal and usually defines the next steps in the treatment.
What happens if the margins are not clear?
Positive or compromised margins
When surgical margins are positive, it means that cancer cells remain in the body, which increases the risk of recurrence. In these cases, the medical team may recommend:
- Another surgery to enlarge the resection.
- Additional treatments to remove the remaining cells.
Implications for treatment
Depending on the type of tumour, its location and the patient’s general condition, other strategies may be used, such as:
- Radiotherapy
- SBRT
- Chemotherapy
- Targeted therapies or immunotherapy
- Percutaneous ablation
These decisions are made on an individual basis and agreed upon by the multidisciplinary team.
Factors influencing the achievement of clear surgical margins
Tumour location and type
Some tumours are more difficult to remove completely due to their size, shape or proximity to vital structures. For example, tumours in the rectum, pancreas, liver metastases close to arteries and veins in the liver, and tumours in the cervicofacial region present specific surgical challenges.
Gastric tumours with signet ring cells require wider margins than other types of tumours due to their aggressiveness and pattern of spread.
Sarcomas require en bloc resection with adequate surgical margins.
Surgical team experience
A highly specialised surgical team, such as the one at IVOQA, is key to achieving clear margins in complex tumours. Experience, training and the use of advanced technology make all the difference.
What role does IVOQA play in precision cancer surgery?
Technology and a multidisciplinary approach
At IVOQA, we use cutting-edge surgical techniques such as minimally invasive surgery, advanced laparoscopy and robotic surgery, as well as 3D modelling for surgical planning.
These are combined with the joint work of surgical oncologists, medical oncologists, radiologists and pathologists for a comprehensive assessment.
Some advanced techniques such as IRE (irreversible electroporation) are revolutionising the treatment of pancreatic cancer with vascular involvement, enabling a greater number of patients with unresectable pancreatic cancer to undergo surgery.
Commitment to patient oncological safety
Our goal is to ensure that every patient receives the best possible surgical option, with clear margins as a standard of quality. IVOQA is a national leader in highly complex surgery, including advanced or metastatic cancers.
Having clear surgical margins means that the tumour has been completely removed, leaving no malignant cells in the body. This result is a fundamental pillar for improving prognosis and reducing the risk of recurrence.
At IVOQA, we work with a precision and personalised surgical approach, tailored to each type of tumour and patient. If you are undergoing treatment or seeking a second opinion, we invite you to consult us for a comprehensive and rigorous evaluation. We are here to help you with commitment, science and experience.
