Do positive resection margins after ablative surgery for head and neck cancer adversely affect prognosis? A study of 352 patients with recurrent carcinoma following radiotherapy treated by salvage surgery

Abstract

SummaryIt is generally accepted by surgeons that failure to eradicate malignant disease at the primary site has an adverse effect on survival. The present study investigates 352 patients with squamous carcinoma of the head and neck treated by primary radical radiotherapy and who subsequently underwent surgical ablation for a recurrent carcinoma. A total of 303 (86%) patients had a negative resection margin and 49 (14%) had a positive resection margin. Oral carcinoma was 1.7 times more likely to be associated with a positive margin than other tumours (P=0.0292). Actuarial calculations demonstrated that 47% of patients with negative margins and 66% of patients with positive margins developed a primary site recurrence (P=0.0286). Neck node recurrence occurred in 10% of those patients with negative margins and 12% of patients with positive margins. Patients with positive margins had a significantly poorer survival than those with negative margins (P = 0.022). Multivariate analysis failed to confirm any independent adverse effect from a positive margin. The 5 year tumour-specific survival of patients with a positive margin was poorer by 12% than for those patients with a negative margin. The pattern of failure differed between the two groups, with patients having positive margins tending to die of local recurrence.

Densidade microvascular no carcinoma de língua

“…Os carcinomas epidermóides da língua são as neoplasias malignas mais freqüentes na boca. Quando operados em estádio avançado, esses tumores apresentam maior índice de margens comprometidas e, nestas circunstân-cias, menor resposta ao tratamento radioterápico adjuvante 1,2 . No momento, não existem meios de identificar os pacientes que, ainda que estejam com doença em estádio inicial, precisam de tratamento mais agressivo, ou aqueles com doença em estádio avançado que não se beneficiam com as alternativas terapêuticas disponíveis.…”

Valor prognóstico da espessura tumoral no carcinoma epidermóide de boca e orofaringe

“…Apesar do maior percentual de comprometimento da margem cirúr-gica nos tumores com espessura maior ou igual a 5 mm (Tabela 3), este fator não é um indicador fidedigno do risco de recidiva 15 . Além disto, muitos pacientes nesta casuística foram perdidos de seguimento precocemente, impedindo uma análise deste parâmetro.…”

Intraoperative frozen section histological analysis of resection samples is useful for the control of primary lesions in patients with oral squamous cell carcinoma

“…These cases reflect the limitations of our FS method in assisting with determining a reliable tumor resection range, in addition to the difficulties involved in imaging diagnosis of tumors located in regions with a complex anatomical structure, such as advanced upper and lower gingival cancers containing hard as well as soft tissues. The prognosis for cases with recurrence is very poor (23,24). To determine the resection range for the primary lesion in such cases, further improvements are required in the imaging evaluation of jaw bone infiltration, tumor invasion pattern and infiltration into the surrounding soft tissues in consideration of the direction of tumor advancement (25).…”