An Analysis of Tumor Margin Shrinkage in the Surgical Resection of Squamous Cell Carcinoma of the Oral Cavity

Burns, Caitlin; Faz, Manel Gorina

doi:10.7759/cureus.15329

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…A reasonable explanation for this observation could be a difference in tissue shrinkage after resection and in the course of pathological processing. This theory has been discussed by other authors and may be responsible for a part of the observed discrepancies [ 24 – 27 ]. It seems comprehensible that contractile soft tissue from the tongue or the buccal mucosa displays a different pattern of shrinkage than tissue from the hard palate.…”

Section: Discussionmentioning

confidence: 76%

Variation of resection margins in oral cancer in dependence of tumor stage and subsite – a retrospective cohort study

Moratin,

Horn,

Oehme

et al. 2024

Clin Oral Invest

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Objectives Surgical resection is a key component of the treatment of head and neck cancer and the achievement of free surgical margins are essential for the patients’ outcome in terms of survival. While there is a general recommendation for a free resection range of 5 mm, up to date, there is a lack of investigations on the quality of tumor resection in dependence of affected subsite and tumor stage. In the presented study, predictors for the achieved resection margins in surgically treated oral squamous cell carcinomas were analyzed. Materials and methods A cohort of 567 patients was included in a retrospective analysis and resection status with exact margin ranges were analysed. Tumor stage, affected subsite and the results of the intraoperative frozen section analysis were assessed. Primary endpoint was the achieved resection margin in mm, secondary endpoints were overall and progression-free survival. Results The observed mean values of minimal resection margins differed significantly between the investigated subsites (p = 0.042),pathological tumor stages (p < 0.001) and in tumors which demonstrated perineural infiltration (Pn1, p = 0.002). Furthermore, there was a significant impact of the results of the intraoperative frozen section analysis on progression-free and overall survival (p < 0.001). Conclusions Our data clearly indicate that resection status differs between tumors of different subsites and tumor stages. Clinical relevance Clinical procedures should be adapted in order to achieve similar certainty in all resections, and, thus to improve patients’ outcome.

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Section: Discussionmentioning

confidence: 76%

Variation of resection margins in oral cancer in dependence of tumor stage and subsite – a retrospective cohort study

Moratin,

Horn,

Oehme

et al. 2024

Clin Oral Invest

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“…As perfusion stops, mucosa specimens can shrink significantly (10%-47%) in oral cavity resections. 5,6 Using computer-assisted design software, the scan could be artificially enlarged by tissue-defined percentages. However, this is highly variable depending on tissue type and would need further investigation, especially as advanced tumors (T3/T4) have been reported to shrink less and more irregularly.…”

Section: Discussionmentioning

confidence: 99%

“…A complex topic warranting further investigation is mucosal shrinkage. As perfusion stops, mucosa specimens can shrink significantly (10%‐47%) in oral cavity resections 5,6 . Using computer‐assisted design software, the scan could be artificially enlarged by tissue‐defined percentages.…”

Section: Discussionmentioning

confidence: 99%

Virtual Resection Specimen Interaction Using Augmented Reality Holograms to Guide Margin Communication and Flap Sizing

Necker

Chang

Leuze

et al. 2023

Otolaryngol.--head neck surg.

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Head and neck surgeons often have difficulty in relocating sites of positive margins due to the complex 3‐dimensional (3D) anatomy of the head and neck. We introduce a new technique where resection specimens are 3D scanned with a smartphone, annotated in computer‐assisted design software, and immediately visualized on augmented reality (AR) glasses. The 3D virtual specimen can be accurately superimposed onto surgical sites for orientation and sizing applications. During an operative workshop, a surgeon using AR glasses projected virtual, annotated specimen models back into the resection bed onto a cadaver within approximately 10 minutes. Colored annotations can correspond with pathologic annotations and guide the orientation of the virtual 3D specimen. The model was also overlayed onto a flap harvest site to aid in reconstructive planning. We present a new technique allowing interactive, sterile inspection of tissue specimens in AR that could facilitate communication among surgeons and pathologists and assist with reconstructive surgery.

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“…Furthermore, variable capacities in margin status prediction could result from the different intraoperative methods used to assess resection margins [ 127 ] and postresection shrinkage [ 131 ]. In particular, the reduction of tumor margin measurements (shrinkage), which occurs between the surgical pre-incision/excision processes and the histopathological evaluation [ 132 ], has been proposed as a potential cause for close pathological margins and requires prudential considerations by surgeons at the initial planning of resection margins.…”

Section: Discussionmentioning

confidence: 99%

Adding Concomitant Chemotherapy to Postoperative Radiotherapy in Oral Cavity Carcinoma with Minor Risk Factors: Systematic Review of the Literature and Meta-Analysis

Rito¹,

Fiorica

Carbonara

et al. 2022

Cancers

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When presenting with major pathological risk factors, adjuvant radio-chemotherapy for oral cavity cancers (OCC) is recommended, but the addition of chemotherapy to radiotherapy (POCRT) when only minor pathological risk factors are present is controversial. A systematic review following the PICO-PRISMA methodology (PROSPERO registration ID: CRD42021267498) was conducted using the PubMed, Embase, and Cochrane libraries. Studies assessing outcomes of POCRT in patients with solely minor risk factors (perineural invasion or lymph vascular invasion; pN1 single; DOI ≥ 5 mm; close margin < 2–5 mm; node-positive level IV or V; pT3 or pT4; multiple lymph nodes without ENE) were evaluated. A meta-analysis technique with a single-arm study was performed. Radiotherapy was combined with chemotherapy in all studies. One study only included patients treated with POCRT. In the other 12 studies, patients were treated with only PORT (12,883 patients) and with POCRT (10,663 patients). Among the patients treated with POCRT, the pooled 3 year OS rate was 72.9% (95%CI: 65.5–79.2%); the pooled 3 year DFS was 70.9% (95%CI: 48.8–86.2%); and the pooled LRFS was 69.8% (95%CI: 46.1–86.1%). Results are in favor of POCRT in terms of OS but not significant for DFS and LRFS, probably due to the heterogeneity of the included studies and a combination of different prognostic factors.

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An Analysis of Tumor Margin Shrinkage in the Surgical Resection of Squamous Cell Carcinoma of the Oral Cavity

Abstract: Burns et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 7 publications

References 15 publications

Variation of resection margins in oral cancer in dependence of tumor stage and subsite – a retrospective cohort study

Variation of resection margins in oral cancer in dependence of tumor stage and subsite – a retrospective cohort study

Virtual Resection Specimen Interaction Using Augmented Reality Holograms to Guide Margin Communication and Flap Sizing

Adding Concomitant Chemotherapy to Postoperative Radiotherapy in Oral Cavity Carcinoma with Minor Risk Factors: Systematic Review of the Literature and Meta-Analysis

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