Resection margins in oral cancer surgery: Room for improvement

Smits, Roeland W.H.; Koljenović, Senada; Hardillo, José A.; Hove, Ivo ten; Meeuwis, Cees A.; Sewnaik, Aniel; Dronkers, Emilie A. C.; Schut, Tom C. Bakker; Langeveld, Ton P. M.; Molenaar, Jan Willem; Hegt, Vincent Noordhoek; Puppels, Gerwin J.; Jong, Robert J. Baatenburg de

doi:10.1002/hed.24075

Cited by 136 publications

(116 citation statements)

References 28 publications

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“…To achieve a better local control, the surgeon should try to obtain both superficial and deep clear margins. Considering that inadequate resection margins are reported between 30% and 65%, this represents a difficult task for the clinician. Recently, the intraoperative use of narrow band imaging (NBI) emerged as a promising tool to help the surgeon in the assessment of the real superficial extension of oral, oropharyngeal, and laryngeal cancer .…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer

et al. 2018

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Objectives Piecemeal resection provides an innovative conceptual tool for margins surveillance because it entails the intraoperative evaluation of the whole resection margins and not just sample points, which should result in a better control of deep margins compared to en bloc resection. Although it is recognized that the intraoperative use of narrow band imaging (NBI) results in a better control of superficial margins, in this exploratory study we investigated whether NBI and piecemeal resection could be used in combination to improve margin control at both superficial and deep levels. Because piecemeal resection is based on frozen section analysis, we wanted to verify its reliability compared to definitive histological examination. Methods The status of resection margins in a group of patients with oral and oropharyngeal cancers treated with NBI and laser CO2 piecemeal resection (group 1) was compared with that of an historical group of patients (group 2) treated with NBI and conventional en bloc resection. In group 1, sensitivity, specificity, and positive and negative predictive values were used to verify the rate of concordance between frozen section and definitive histology. Results The difference between deep positive margins in the two groups was statistically significant (P = 0.042). The high sensitivity and specificity (94.6% and 94.7%, respectively) of frozen section analysis also demonstrated its reliability in the examination of larger samples corresponding to the whole margin. Conclusion Even if our findings are limited by the small number of patients, we are confident that the combined use of NBI and piecemeal resection could represent an attractive surgical strategy to improve margin control. Level of Evidence 2b Laryngoscope, 129:1810–1815, 2019

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Section: Introductionmentioning

confidence: 99%

Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer

et al. 2018

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“…Tongue squamous cell carcinoma (TSCC) is the most common malignancy in the head and neck region and is primarily treated surgically [1–5]. Goal of the surgical resection is to completely remove the tumor with adequate resection margins, to avoid the need for subsequent additional treatment such as repeated surgery or (chemo-) radiotherapy and to minimize functional impairment related to the procedure.…”

Section: Introductionmentioning

confidence: 99%

“…Although definite information on the deep resection margins requires postoperative histopathological analysis, peroperative information on the resection margins could help to optimize resection volume. Unfortunately, definite information on these resection margins is not yet available during surgery [1, 2]. Translation of information from preoperative imaging into the actual situation in the patient during surgery is challenging; macroscopic evaluation of a tumor in the tongue by palpation during surgery is difficult and inaccurate, and peroperative biopsies or frozen sections may suffer from sample error.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of tongue squamous cell carcinoma resection margins using ex-vivo MR

et al. 2017

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PurposePurpose of this feasibility study was (1) to evaluate whether application of ex-vivo 7T MR of the resected tongue specimen containing squamous cell carcinoma may provide information on the resection margin status and (2) to evaluate the research and developmental issues that have to be solved for this technique to have the beneficial impact on clinical outcome that we expect: better oncologic and functional outcomes, better quality of life, and lower costs.MethodsWe performed a non-blinded validation of ex-vivo 7T MR to detect the tongue squamous cell carcinoma and resection margin in 10 fresh tongue specimens using histopathology as gold standard.ResultsIn six of seven specimens with a histopathologically determined invasion depth of the tumor of mm, the tumor could be recognized on MR, with a resection margin within a 2 mm range as compared to histopathology. In three specimens with an invasion depth of mm, the tumor was not visible on MR. Technical limitations mainly included scan time, image resolution, and the fact that we used a less available small-bore 7T MR machine.ConclusionEx-vivo 7T probably will have a low negative predictive value but a high positive predictive value, meaning that in tumors thicker than a few millimeters we expect to be able to predict whether the resection margin is too small. A randomized controlled trial needs to be performed to show our hypothesis: better oncologic and functional outcomes, better quality of life, and lower costs.

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“…Complete removal of primary tumour with respect to precise surgical margins is an important factor deciding prognosis for many cancers including oral cancer. Despite progress in imaging techniques, the clinical outcome of the patients with oral squamous cell carcinoma (OSCC) is unsatisfactory, as the reported 5-year survival rate is 50%, which is mainly due to the incomplete removal of primary tumour1. The detection of oral carcinoma using 5-aminolevulinic acid (5-ALA)-induced PPIX fluorescence has recognized histologically malignant tissues and shown clear cut margins in 63% cases, keratinization of the tissues was the limitation for accurate diagnosis2.…”

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confidence: 99%

TM1-IR680 peptide for assessment of surgical margin and lymph node metastasis in murine orthotopic model of oral cancer

Kochurani

Nair

et al. 2016

Sci Rep

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Treatment outcome after surgical removal in oral carcinoma is poor due to inadequate methodologies available for marking surgical margins. Even though some methodologies for intraoperative margin assessment are under clinical and preclinical trials for other solid tumours, a promising modality for oral cancer surgery is not developed. Fluorescent-based optical imaging using Near Infrared (NIR) dyes tagged to tumour specific target will be an optimal tool for this purpose. One such target, Gastrin Releasing Peptide Receptor (GRPR) was selected for the study, and its binding peptide, TM1-IR680, was tested for its efficacy for surgical margin prediction in murine orthotopic model of oral cancer, derived from primary samples. Here, for the first time in a preclinical analysis, we show that the size and margin of oral cancer can be predicted, as revealed by 3D-imaging. Interestingly, the peptide was sensitive enough to detect lymph nodes that harboured dispersed tumour cells before colonization, which was impossible to identify by conventional histopathology. We recommend the use of TM1-NIR dyes alone or in combination with other technologies to improve the clinical outcome of oral cancer surgery.

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Resection margins in oral cancer surgery: Room for improvement

Cited by 136 publications

References 28 publications

Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer

Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer

Evaluation of tongue squamous cell carcinoma resection margins using ex-vivo MR

TM1-IR680 peptide for assessment of surgical margin and lymph node metastasis in murine orthotopic model of oral cancer

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