Surgical margins and primary site resection in achieving local control in oral cancer resections

Abstract

4.

How Close Are We to Real Time Optical Margin Control in Head and Neck Oncologic Surgery?

“…The authors noted that reliance on margin sampling from the tumor bed is associated with worse local control [43] . This finding was also noted in a single center trial that noted a statistical improvement in local control, disease-free, and overall survival with increasing radial margin distance from the tumor [44] . Currently there are no recommended standards to guide surgeons regarding appropriate surgical margin sampling.…”

Positive frozen section margins predict local recurrence in R0-resected squamous cell carcinoma of the head and neck

“…Reliance on tumour bed margins appears to be associated with even worse local control, perhaps due to the narrower initial resection [28]. Despite these critics on frozen section analysis there are of course also studies showing the benefit of frozen sections, particularly in comparison to patients with permanent positive margins [10,29]. Byers et al for example reviewed 216 patients with squamous cell carcinoma of the head and neck [29].…”

“…Varvares et al also reported an increased hazard (HR = 20) of local recurrence for initial positive frozen section margins that were revised into negative ones compared to an initial complete resection with 5 mm margins. Nevertheless additional resection resulted in improvement of outcome compared to patients with consistently positive margins [10]. The high rate of local recurrence after tumour surgery with positive margins in intraoperative frozen section analysis raises the question of value of this method.…”

“…However there is no uniformity in the definition of an adequate width of resection margin. Within the oral cavity 5 mm on formalin-fixed tumour specimen represents the most commonly used standard [6,7,10,15]. However there are also studies recommending different cut-offs [8,14,16].…”

“…In case of positive margins (microscopic tumour cut through) frozen section analysis should help the surgeon to revise the resection and to obtain negative margins at the end of surgery. However, the prognostic and therapeutic implication of positive frozen section margins revised to negative margins remains unclear and controversial [10][11][12]. The scope of the current investigation was to evaluate the impact of both frozen section and permanent margin status on local, regional and distant http://dx.…”