Revision of margins under frozen section in oral cancer: a retrospective study of involved margins in pT1 and pT2 oral cancers

Gokavarapu, Sandhya; Rao, L.M. Chandrasekhara; Mahajan, Munish; Parvataneni, Nagendra; Raju, K. V. V. N.; Chander, Ravi

doi:10.1016/j.bjoms.2015.08.257

Cited by 16 publications

(20 citation statements)

References 20 publications

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“…Most recent studies also show that the use of FS for positive margin revision does not improve local control when compared to initially clear margins. [9][10][11][13][14][15][16]40,41 However, when evaluating the literature, it is difficult to compare studies because of the different margin cutoffs used and subsites analyzed. In our review, we tried to harmonize the data from these studies by (1) including only patients with primary OCSCC and no previous treatment, (2) defining negative margins as 5 mm on initial resection, and (3) excluding patients with close margins who did not undergo revision.…”

Section: Discussionmentioning

confidence: 99%

Does Clearance of Positive Margins Improve Local Control in Oral Cavity Cancer? A Meta‐analysis

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Tarabichi

Sethi

et al. 2019

Otolaryngol.--head neck surg.

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Objectives To compare local recurrence-free survival (LRFS) in early oral cavity cancer (OCC) patients with positive/close frozen section (FS) cleared with further resection (R1 to R0) or positive FS not cleared (R1) to those with negative margins on initial FS analysis (R0). Data Sources PubMed, EMBASE, and Cochrane. Review Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for reporting in our study. Only English-language articles that included patients with OCC and local recurrence (LR) comparisons between R0 and initially R1 to final R0 or final R1 groups were included. We requested the raw data from the corresponding authors of eligible studies and performed an individual participant data (IPD) meta-analysis of LRFS outcomes across groups. Results Pooled LRFS data from 8 studies showed that patients in the R1 to R0 group had worse LRFS compared to the R0 group (hazard ratio [HR] = 2.897, P < .001). Patients in the R1 group were also found to have worse LRFS compared to the R0 group (HR = 3.795, P < .001). When compared to final R1 group, the initially R1 to final R0 only showed a trend toward better LRFS. Conclusion Margin revision of initially positive margins to “clear” based on FS guidance does not equate to an initially negative margin and does not significantly improve local control. These findings call into question the effectiveness of the current methodology of intraoperative FS in OCC resections and call for a prospective study to determine what system of resected specimen analysis best predicts completeness of resection.

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Section: Discussionmentioning

confidence: 99%

Does Clearance of Positive Margins Improve Local Control in Oral Cavity Cancer? A Meta‐analysis

Bulbul

Tarabichi

Sethi

et al. 2019

Otolaryngol.--head neck surg.

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“…According to the current guidelines of the AJCC, specimen‐driven intraoperative assessment is the standard of care . Although powerful, the impact of intraoperative assessment is negatively influenced by the lack of accurate relocation of inadequate margins for optimal additional resection towards adequate surgery . As a result, various studies have reported an accurate additional excision for initial tumor‐positive margins in only 22.5%‐50% of the cases .…”

Section: Discussionmentioning

confidence: 99%

“…Although intraoperative assessment can be beneficial with both specimen‐driven and wound bed‐driven, either method lacks an accurate relocation of the inadequate margin. It is known that relocation is particularly difficult in the head and neck region, and therefore an optimal additional resection is not always achieved …”

Section: Introductionmentioning

confidence: 99%

Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study

et al. 2019

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Background Specimen‐driven intraoperative assessment of the resection margins provides immediate feedback if an additional excision is needed. However, relocation of an inadequate margin in the wound bed has shown to be difficult. The objective of this study is to assess a reliable method for accurate relocation of inadequate tumor resection margins in the wound bed after intraoperative assessment of the specimen. Methods During oral cavity cancer surgery, the surgeon placed numbered tags on both sides of the resection line in a pair‐wise manner. After resection, one tag of each pair remained on the specimen and the other tag in the wound bed. Upon detection of an inadequate margin in the specimen, the tags were used to relocate this margin in the wound bed. Results The method was applied during 80 resections for oral cavity cancer. In 31 resections an inadequate margin was detected, and based on the paired tagging an accurate additional resection was achieved. Conclusion Paired tagging facilitates a reliable relocation of inadequate margins, enabling an accurate additional resection during the initial surgery.

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“…For the detection of inadequate margins during OCSCC surgery, this defect-driven frozen section procedure has been shown to have low sensitivity (5)(6)(7)(8)(9). Moreover, this procedure is time-consuming and only a limited number of tissue samples can be examined, leading to sampling error, and resulting in underestimation of inadequate margins (10)(11)(12)(13)(14)(15). Furthermore, the defect-driven frozen section procedure cannot provide the exact length of resection margins (in millimeters); it can only indicate the presence of tumor-positive margins.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Assessment of the Resection Specimen Facilitates Achievement of Adequate Margins in Oral Carcinoma

et al. 2020

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BackgroundInadequate resection margins in oral cavity squamous cell carcinoma have an adverse effect on patient outcome. Intraoperative assessment provides immediate feedback enabling the surgeon to achieve adequate resection margins. The goal of this study was to evaluate the value of specimen-driven intraoperative assessment by comparing the margin status in the period before and the period after the introduction of specimen-driven assessment as a standard of care (period 2010–2012 vs period 2013–2017).MethodsA cohort of patients surgically treated for oral squamous cell carcinoma at the Erasmus MC Cancer Institute, Rotterdam, between 2010–2012 was studied retrospectively and compared to results of a prospectively collected cohort between 2013–2017. The frequency, type and results of intraoperative assessment of resection margins were analyzed.ResultsOne hundred seventy-four patients were included from 2010–2012, 241 patients were included from 2013–2017. An increase in the frequency of specimen-driven assessment was seen between the two periods, from 5% in 2010–2012 to 34% in 2013–2017. When performing specimen-driven assessment, 16% tumor-positive resection margins were found in 2013–2017, compared to 43% tumor-positive resection margins overall in 2010–2012. We found a significant reduction of inadequate resection margins for specimen-driven intraoperative assessment (p < 0.001). Also, tumor recurrence significantly decreased, and disease-specific survival improved when performing specimen-driven intraoperative assessment.ConclusionsSpecimen-driven intraoperative assessment improves resection margins and consequently, the outcome of oral cancer patients. We advocate this method as standard of care.

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Revision of margins under frozen section in oral cancer: a retrospective study of involved margins in pT1 and pT2 oral cancers

Cited by 16 publications

References 20 publications

Does Clearance of Positive Margins Improve Local Control in Oral Cavity Cancer? A Meta‐analysis

Does Clearance of Positive Margins Improve Local Control in Oral Cavity Cancer? A Meta‐analysis

Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study

Intraoperative Assessment of the Resection Specimen Facilitates Achievement of Adequate Margins in Oral Carcinoma

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