Table 3.

Operative considerations in isolating tumor-infiltrating lymphocytes (TILs)

Consideration	Details
Tumor size	Tumor size does not correlate with TIL efficacy, but tumors should be at least 2 cm in largest diameter to obtain adequate yield of tissue for processing.
Irradiated tumors	Avoid harvesting TILs from a tumor site that has previously been irradiated.
Tumor site	Because TILs can be procured from a variety of tumor sites, favor surgical sites that result in minimal morbidity and consider laparoscopic approach.
Margins	Wide surgical margins and major organ resection are not typically necessary unless the tumor resection is being performed for curative intent. Avoid cutting through tumor to minimize risk of seeding tumor site.
Wound healing	Avoid harvest of superficial lesions if wound healing may be compromised.
Contamination	Ulcerating tumors and those with high suspicion for bacterial colonization can result in contamination of cultures. Isolation of TILs from bowel lesions is possible but may be associated with an increased risk of contamination.
Splenic lesions	Splenic tumors are not optimal for TILs because of theoretical concern that they may be enriched in bystander lymphocytes that are not tumor-reactive.
CNS lesions	Tumors metastatic to CNS have not been adequately assessed as a source of TILs for treatment.
Harvest	Refer to institutional guidelines for instructions on handling, processing, and labeling of tumor specimens.
Confirmation	Confirmation that the metastasectomy specimen contains malignant cells will ensure that benign or nodal tissue has not been inadvertently collected.

CNS central nervous system