Significance of post-resection tissue shrinkage on surgical margins of oral squamous cell carcinoma

El-Fol, Hossam Abdelkader; Noman, Samer Abduljabar; Beheiri, Mohamed Galal; Khalil, Abdalla M.; Kamel, Mahmoud M.

doi:10.1016/j.jcms.2015.01.009

Cited by 50 publications

(50 citation statements)

References 33 publications

(36 reference statements)

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“…[5,25] Indeed, the main goal of the resective surgery of the head and neck is the complete removal of the tumor with suitable margins of resection free of disease. [23] However, even at the present day, there has not been consensus between researches on what constitutes tumor involvement at the resection margin (including mucosal dysplasia or carcinoma in situ) and what constitutes an "adequate" margin of resection. [7,8,18] Though controversial, it seems reasonable to accept, based on studies, that 5 mm of healthy tissue around the tumor should be the minimum acceptable margin size for a clear surgical margin in any oral SCC.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the invasive character of oral SCC can lead to occult microscopic margins, finger extensions or islands of tumor that extend beyond the clinically visible and palpable tumor, obtaining a margin that is closer than previously expected. [20,23] Moreover, it should be kept in mind that malignant molecular changes may be present even when there are histopathologic normal margins. [26] Nevertheless, it seems clear that the discrepancy observed between clinical and pathological margins is most often associated to shrinkage phenomenon after resection.…”

Section: Discussionmentioning

confidence: 99%

“…[26] Nevertheless, it seems clear that the discrepancy observed between clinical and pathological margins is most often associated to shrinkage phenomenon after resection. [23] The aim of this literature review was to identify studies that discussed the tissue shrinkage phenomenon on surgical margins of resection in patients underwent surgery for oral and oropharynx SCC. Only four articles were finally included in this review according to our search strategy (one prospective, one retrospective and two articles not defined).…”

Section: Discussionmentioning

confidence: 99%

“…In their study, Cheng et al [20] informed a mean discrepancy between the in situ margins and the histopathologic margins for all patients of 59.02% (P < 0.001). However, El-Fol et al [23] described a mean discrepancy between intraoperative margins and histopathologic margins exclusively analyzing all close and positive margins. In this study, the mean discrepancy for buccal mucosa was 47.6%, 33.3% for the tongue, 9.5% for the mandibular alveolus, and 4.8% for both, retromolar trigon and floor of the mouth.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The patients were grouped by locations obtaining the following statistically significant result: mean discrepancy for group 1 (buccal mucosa, mandibular alveolar ridge and retromolar trigone) 71.90%, 53.33% for group 2 (maxillary alveolar ridge and palate) and 42.14% for group 3 (oral tongue), with a P value corresponding to 0.0133. Likewise, El-Fol et al [23] measured the difference between the "in situ" margins and "histopathologic" margins of 61 patients that underwent resective surgery for oral SCC. A significant difference in the measurement of resection margin according to the anatomical site was obtained with a mean of discrepancy of 66.7% for buccal mucosa, a 35% for the tongue, a 33.3% for the floor mouth, a 16.7% for the retromolar trigone and a 15.4% for the mandibular alveolus.…”

Section: Shrinkage Depending On the Tumor Sitementioning

confidence: 99%

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The tissue shrinkage phenomenon on surgical margins in oral and oropharyngeal squamous cell carcinoma

González-Ballester¹

2016

PAR

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Aim: One of the most important factors associated with recurrence rate and overall survival is the status of surgical margin of resection free of disease. However, sometimes, the margins measured intra-operatively at the time of surgery differ of those measured by the pathologist in the histopathologic analysis. Faced with this dilemma, a literature review of the best available evidence was conducted in an attempt to determine how the phenomenon of tissue shrinkage may influence on the surgical margin of resection in patients undergoing oral and oropharyngeal squamous cell carcinoma (SCC). Methods: An electronic and manual search was conducted by one reviewer. A combination of controlled Medical Subjects Headings and keywords were used as search strategy. Inclusion and exclusion criteria were established. Results: Finally, after an exhaustive selection process, four articles fulfilled the inclusion criteria and were analyzed. All articles reported a decrease of surgical margin after resection. The tumor site and tumor stage seem to influence in degree of margin shrinkage. Conclusion: Tissue shrinkage on surgical margins of resection in oral SCC is a tangible phenomenon. There is a significant discrepancy between margins measured intraoperatively previous to resection and margins measured by pathologist after histologic processing. The highest percentage of retraction occurs at the time of resection. Margin shrinkage based on tumor site and tumor stage should be considered by any oncologic surgeon to ensure adequate margins of resection cleared of tumor.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Shrinkage Depending On the Tumor Sitementioning

confidence: 99%

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The tissue shrinkage phenomenon on surgical margins in oral and oropharyngeal squamous cell carcinoma

González-Ballester¹

2016

PAR

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Survival and recurrence of resectable tongue cancer: Resection margin cutoff value by T classification

et al. 2017

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Ultrasound‐guided resection for squamous cell carcinoma of the buccal mucosa: A feasibility study

et al. 2022

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Background Image‐guided surgery could help obtain clear (≥5.0 mm) resection margins. This feasibility study investigated ultrasound‐guided resection accuracy of buccal mucosa squamous cell carcinoma (BMSCC). Methods MRI and ultrasound measurements of tumor thickness were compared to histology in 13 BMSCC‐patients. Ultrasound measured margins (at five locations) on the specimen were compared to the corresponding histological margins. Results Accuracy of in‐ and ex‐vivo ultrasound (mean deviation from histology: 1.6 mm) for measuring tumor thickness was comparable to MRI (mean deviation from histology: 2.6 mm). The sensitivity to detect clear margins using ex‐vivo ultrasound was low (48%). If an ex‐vivo ultrasound cutoff of ≥7.5 mm would be used, the sensitivity would increase to 86%. Conclusions Ultrasound‐guided resection of BMSCC's is feasible. In‐ and ex‐vivo ultrasound measure tumor thickness in BMSCC accurately. We recommend ≥7.5 mm resection margins on ex‐vivo ultrasound to obtain histological clear margins. Additional research is required to establish the effect of 7.5 mm ultrasound cutoff.

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Significance of post-resection tissue shrinkage on surgical margins of oral squamous cell carcinoma

Cited by 50 publications

References 33 publications

The tissue shrinkage phenomenon on surgical margins in oral and oropharyngeal squamous cell carcinoma

The tissue shrinkage phenomenon on surgical margins in oral and oropharyngeal squamous cell carcinoma

Survival and recurrence of resectable tongue cancer: Resection margin cutoff value by T classification

Ultrasound‐guided resection for squamous cell carcinoma of the buccal mucosa: A feasibility study

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