Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members

Abstract

Objectives/Hypothesis: To investigate the definition of a clear margin and the use of frozen section (FS) among practicing head and neck surgeons in oral cancer management. Study Design: Cross-sectional survey. Methods: We designed a survey that was sent to American Head and Neck Society (AHNS) members via an email link. Results: A total of 185 (13% of 1,392) AHNS members completed our survey. Most surgeons surveyed (96.8%) use FS to supplement oral cavity squamous cell carcinoma resections. Fifty-five percent prefer a specimen-based approach. The majority of respondents believe FS is efficacious in guiding re-resection of positive margins, with 81% considering the new margin to be negative. More than half of respondents defined a distance of >5 mm on microscopic examination as a negative margin. Conclusions: To avoid oral cancer resections that result in positive margins on final analysis, and thus the need for additional therapy, most surgeons surveyed use FS. A majority of surveyed surgeons now prefer a specimen-based approach to margin assessment. Although there is a debate on what constitutes a negative margin, most surgeons surveyed believe it to be >5 mm on microscopic examination.

The impact of intraoperative frozen section analysis on final resection margin status, recurrence, and patient outcome with oral squamous cell carcinoma

“…As re-resection of initial positive or close margins turned into definite R0 status, we did not observe statistical differences compared to cases with initial negative IFSA. Our result contradicts the findings of other recent studies that treat formally revised R0 status as positive margins and assign adjuvant therapy [12,26,27]. In our analysis, IFSA led to worthy prognostic information for adequate resection provided by clear affiliations of the specimen as well as close cooperation of the surgeons with pathologists.…”

“…Recently, specimen-driven sampling is reported to be safer in terms of gaining reliable information about the margins and is also reported to have lower local recurrence rates [14,19]. Bulbul et al (2020) revealed in a survey of American Head and Neck Society members that 55% apply specimendriven and 45% tumor bed-driven intraoperative sampling. In the case of close or positive resection margins, an immediate intraoperative re-resection should be performed aiming for clear surgical margins.…”

“…In the case of close or positive resection margins, an immediate intraoperative re-resection should be performed aiming for clear surgical margins. The definition of free resection margin is still controversially debated but is commonly understood to be a distance of at least 5 mm from the infiltrative boundary [12]. However, the definitions of safety margins have varied in literature between 2 and 10 mm [16,21].…”

“…The complete carcinoma resection with adequate distance to the resection margins (R0 status) is the primary objective of curative intended surgical treatment, and the impact of the final resection margin status on disease recurrence and patient outcome is well described [5][6][7]. Close (< 5 mm) or positive resection margins (R1 status) are regarded as a major influence on patient prognosis [8][9][10][11][12]. In the case of close or positive margins, re-resection of the primary tumor bed is suggested to obtain R0 status.…”

“…In this context, intraoperative frozen section analysis (IFSA) serves as a diagnostic tool to anticipate intraoperatively adequate resection margins in most Katharina Nentwig, Tobias Unterhuber, Lucas M. Ritschl and Markus Nieberler contributed equally to this work. head and neck centers, according to a survey of American Head and Neck Society members by Bulbul et al [12]. IFSA provides immediate information on the soft tissue resection margins of the main tumor specimen or the former tumor bed and represents the standard means for the surgeon to avoid unnecessary and/or inadequate resections [4,15].…”