The uncertainty of the surgical margin in the treatment of head and neck cancer

Upile, Tahwinder; Fisher, Carl; Jerjes, Waseem; Maaytah, Mohammed El; Searle, A.G.; Archer, Daniel J.; Michaels, L.; Rhys‐Evans, Peter; Hopper, Colin; Howard, DJ; Wright, A.

doi:10.1016/j.oraloncology.2006.08.002

Cited by 80 publications

(66 citation statements)

References 35 publications

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“…The results of this study showed that a deep surgical margin had a significant impact on local recurrence, DSS, and RFS, as seen in previous studies [6,29,[39][40][41]. Some studies have identified an association between the margin status and factors that impact outcome in oral cancer, including the T status, N status, DOI, and POI [6,39,41].…”

Section: Discussionsupporting

confidence: 81%

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Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

Yanamoto

Yamada

Takahashi

et al. 2013

Pathol. Oncol. Res.

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Locoregional recurrence of oral tongue squamous cell carcinoma (OTSCC) has been considered a poor prognostic entity in terms of survival rate.The purpose of this study was to evaluate the incidence of locoregional recurrence and to identify significant risk factors for locoregional recurrence in early-stage OTSCC. We retrospectively reviewed the records of 58 patients who underwent radical surgery for T1-2N0 OTSCC. The local recurrence and regional recurrence rates were 10.3% (6/58 patients) and 15.5% (9/58 patients) in this study, respectively. The survival rate of patients with local recurrence was 66.7%, which was significantly lower than that (96.2%) of patients without local recurrence, whereas the survival rates of patients with or without regional recurrence were not significantly difference. Pattern of invasion (POI), neoadjuvant chemotherapy (NAC) and the status of the surgical margin were identified as factors influencing local recurrence. In particular, the status of the deep surgical margin was a high potential independent risk factor. The deep surgical margin was resected closely in many NAC-treated cases, suggesting that NAC may lead to local recurrence and a poor outcome. No efficacy of NAC was observed, suggesting that the standard treatment for early OTSCC is surgery alone.

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Section: Discussionsupporting

confidence: 81%

“…Some studies have identified an association between the margin status and factors that impact outcome in oral cancer, including the T status, N status, DOI, and POI [6,39,41]. In this study, POI and NAC were significantly associated with a closed deep surgical margin.…”

Section: Discussionmentioning

confidence: 49%

Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

Yanamoto

Yamada

Takahashi

et al. 2013

Pathol. Oncol. Res.

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“…Radial margins, on the other hand, are those taken where one is purposely sampling the tumor and the leading edge of a resection perpendicularly in the same histologic section so that the margin can be seen, and the distance from the tumor to the margin observed. The defect sampling method (which is essentially a form of shave margin) is becoming increasingly common, particularly as a result of transoral laser microsurgery 8,9 in which the tumor is removed in multiple pieces, leaving defect sampling as the major method to clearly assess margins.…”

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confidence: 99%

Frozen section analysis of margins for head and neck tumor resections: reduction of sampling errors with a third histologic level

2011

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Frozen section analysis is an essential tool for assessing margins intra-operatively to assure complete resection. Many institutions evaluate surgical defect edge tissue provided by the surgeon after the main lesion has been removed. With the increasing use of transoral laser microsurgery, this method is becoming even more prevalent. We sought to evaluate error rates at our large academic institution and to see if sampling errors could be reduced by the simple method change of taking an additional third section on these specimens. All head and neck tumor resection cases from January 2005 through August 2008 with margins evaluated by frozen section were identified by database search. These cases were analyzed by cutting two levels during frozen section and a third permanent section later. All resection cases from August 2008 through July 2009 were identified as well. These were analyzed by cutting three levels during frozen section (the third a 'much deeper' level) and a fourth permanent section later. Error rates for both of these periods were determined. Errors were separated into sampling and interpretation types. There were 4976 total frozen section specimens from 848 patients. The overall error rate was 2.4% for all frozen sections where just two levels were evaluated and was 2.5% when three levels were evaluated (P ¼ 0.67). The sampling error rate was 1.6% for two-level sectioning and 1.2% for threelevel sectioning (P ¼ 0.42). However, when considering only the frozen section cases where tumor was ultimately identified (either at the time of frozen section or on permanent sections) the sampling error rate for two-level sectioning was 15.3 versus 7.4% for three-level sectioning. This difference was statistically significant (P ¼ 0.006). Cutting a single additional 'deeper' level at the time of frozen section identifies more tumor-bearing specimens and may reduce the number of sampling errors.

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“…[19] Currently, following the surgical standard, it has been established that a macroscopic surgical margin of 1 to 2 cm obtained intra-operatively is enough extent to obtain a free-tumor margin (5 mm at present) in the oral cavity and oropharynx. [3,[19][20][21] Nevertheless, sometimes it happens that, despite surgical margins measured by the surgeon intra-operatively seem appropriate, a notable discrepancy is observed when are analyzed by the pathologist under the microscope. Faced with this dilemma, a review of the best available evidence in the literature regarding to the tissue shrinkage phenomenon observed on surgical margins of resection in patients with oral and oropharyngeal SCC was carried out.…”

Section: Introductionmentioning

confidence: 99%

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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The uncertainty of the surgical margin in the treatment of head and neck cancer

Cited by 80 publications

References 35 publications

Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

Predictors of Locoregional Recurrence in T1-2N0 Tongue Cancer Patients

Frozen section analysis of margins for head and neck tumor resections: reduction of sampling errors with a third histologic level

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

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