Involved surgical margins in oral and oropharyngeal carcinoma—an anatomical problem?

McMahon, Jeremy; Devine, J.C.; Hetherington, Jonathan; Bryson, Gareth; McLellan, Douglas; MacIver, Colin; Teasdale, E.; Jampana, Ravi

doi:10.1016/j.bjoms.2010.02.014

Cited by 22 publications

(10 citation statements)

References 11 publications

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“…McMahon et al discussed the importance of using an 'anatomical approach' in the resection of OSCC [16]. When comparing surgical margin adequacy between 2 cohorts a decade apart, they demonstrated that the use of modern imaging and in particular post-acquisition processing to better define tumours reduced the involved margin rate from 37% to 5%.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing the Status of the Surgical Margin in the Resection of Oral Squamous Cell Carcinoma

Payne¹

2017

BJSTR

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Section: Discussionmentioning

confidence: 99%

Factors Influencing the Status of the Surgical Margin in the Resection of Oral Squamous Cell Carcinoma

Payne¹

2017

BJSTR

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“…Surgical techniques providing improved access (such as mandibulotomy or pull through technique) and in continuity resection (where tongue, floor of mouth and neck specimen are removed en block) are employed by some surgeons to achieve better margin clearance, but evidence to support these is lacking. Others have noted that accurate and extensive imaging before surgery can reduce the frequency of involved margins [26,27].…”

Section: Discussionmentioning

confidence: 99%

Excision margins in squamous cell carcinoma of the tongue: A retrospective audit and review of the literature

Thake¹,

Kalantzis²

2013

OJST

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The incidence of close and involved tongue resection margins for squamous cell carcinoma (SCC) were reviewed with the aim to identify any possible need for change in the surgical approach to glossectomies. The histopathological reports of 101 partial glossectomies for SCC between 2006 and 2012 were retrospectively reviewed. Results: Overall 52 (51.5%) patients had one or more close or involved margin and 9 (8.9%) had both close and involved margins. 42 (41.5%) patients had close margins and 11 (10.9%) had involved margins. The inferior/lateral muscoal margin was most frequently close/involved (32%) followed by deep margin (27%). The anterior margin was least close/involved (5%). The posterior and superior/medical margins were close/involved in 12% and 11% of cases respectively. Conclusions: 52.5% of patients had close or involved margins following surgery, potentially requiring further treatment to avoid an increased risk of tumour recurrence and the associated increase in morbidity and mortality. The inferior/lateral and deep margins were most frequently involved possible due to the anatomical difficulties visualising and dissecting these margins. The potential explanations for these disparities and possible solutions are discussed.

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“…Анатомические особенности ротоглотки: небольшой размер, сложное строение, глубокое расположение, смежность с носоглоткой и основанием черепа сверху и со структурами гортани и гортаноглотки снизу -делают возможность широкого отступа от края опухоли постоянно обсуждаемой проблемой. Частота выявления положительного края резекции колеблется от 5 до 38 % [29][30][31]. В подавляющем большинстве сообщений положительный край резекции признан предиктором увеличения частоты местных рецидивов (как минимум в 2 раза) и уменьшения выживаемости, как общей, так и специфической [30,31].…”

Section: рис 4 стоматофарингоскопия пациентки с раком небной миндалunclassified

Surgery for advanced oropharyngeal cancer

Карпенко

Сибгатуллин

Бойко

et al. 2018

Opuholi golovy i šei

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The study objectiveis to assess the results of this approach and identifications of factors that may influence the effectiveness of such an approach.Materials and methods. Since 2009 through 2016 72 patients with stage III and IV aged between 42 and 77 years underwent upfront surgery.Anatomical sites included 34 (46 %) tonsil, 24 (33 %) base of tongue and 14 (21 %) soft palate cases. Transcervical sparing the mandible,mandibulectomy and transoral approaches were used in 42 (58 %), 11 (15 %) and 7 (10 %) patient, respectively. Total glossectomy was performed in 4 (5.5 %) cases. Tumor extension necessitated extended laryngectomy in 8 patients (11.5 %). Primary closure of the pharyngeal wound was possible in 30 patients (42 %). Reconstruction with distant flaps was performed in the remaining 42 patients. Both free (anterolateral thigh – 19, radial forearm flap – 10) and flaps with axial blood supply (pectoralis major – 9, supraclavicular flap – 4) were used. There were 6 T1, 12 T2, 28 T3 and 20 T4 tumors; 62 patients were N-positive: N1 – 10 cases, N2 – 51, N3 – 1. Positive surgical margins were diagnosed in 13 cases (18 %) including 3 cases of R2 resection. Adjuvant radiation therapy with or without chemotherapy was completed in 45 patients (63.4 %). Survival was calculated according to Kaplan–Mayer method.Results.There was 1 death in early postoperative period. Mean follow-up for the remaining patients (n = 71) was 27 months (1–94). Median survival was 27 months (95 % CI 11.5–42.5); 3-year overall survival was 44 %; 33 out of 34 still alive patients are capable to take food orally. Only 1 (2.9 %) patient is gastrostomy tube dependent. Univariate analysis revealed that positive margins (p <0.0001) and completeness of combined treatment (p <0.01) are the main factors that have statistically significan impact on prognosis.Conclusion.Combined approach with upfront surgery is one of the main treatment modalities for advanced oropharyngeal cancer. Modern reconstructive options and strict adherence to a proper surgical technique give a high chance for a valuable rehabilitation for the vast majority of patients. Scrupulous planning of the resection of the primary tumor based on modern imaging techniques and encouraging patients to complete all prescribed treatments are the main physician-related factors that influence survival outcome.

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Involved surgical margins in oral and oropharyngeal carcinoma—an anatomical problem?

Cited by 22 publications

References 11 publications

Factors Influencing the Status of the Surgical Margin in the Resection of Oral Squamous Cell Carcinoma

Factors Influencing the Status of the Surgical Margin in the Resection of Oral Squamous Cell Carcinoma

Excision margins in squamous cell carcinoma of the tongue: A retrospective audit and review of the literature

Surgery for advanced oropharyngeal cancer

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