High-Volume Surgeons Deliver Larger Surgical Margins in Oral Cavity Cancer

Abstract

Purpose:Many factors are involved in oral cavity cancer surgery, and their association with the surgical margin; thus, patient outcomes are still not completely understood. This aim of this study was to determine which variable or variables had the greatest influence on increasing the size of the surgical margin. Methods:A retrospective cohort study was conducted at the Royal Brisbane and Women's Hospital of patients who underwent resective surgery for a primary oral cavity cancer between January 1, 2008 and December 31, 2012. The primary outcome variable was the surgical margin, defined as the closest distance between the surgical edge and invasive cancer. A heterogeneous set of predictor variables were identified as potentially impacting on the primary outcome variable: demographic, 5 surgical, and 7 histological variables. The data then underwent statistical analysis using univariable linear regression, and variables that were found to have a statistical association were retained in a non-interaction multivariable model. Results:250 patients were included in this study. The results demonstrated that highvolume surgeons delivered larger surgical margins than low-volume surgeons.The single most important variable associated with larger surgical margins M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTwas who performed the resective operation. The following variables were also associated with smaller surgical margins: retromolar trigone location; non-SCC cancers; perineural invasion; and a lip-split mandibulectomy surigical approach. Conclusion:There was a strong association between high-volume surgeons and larger surgical margins; supporting the rationalization of oral cavity cancer management into high-volume centers and high-volume surgeons.

Association of Facility Volume With Positive Margin Rate in the Surgical Treatment of Head and Neck Cancer

“…It can be hypothesized that the availability of microvascular free tissue transfer allows for a more aggressive tumor resection to achieve clear margins, despite the potential creation of extensive functional and cosmetic defects. In 2 small retrospective studies on surgically resectable oral cavity squamous cell carcinoma, 12,30 no association was found between the presence of PM and reconstruction with free tissue transfer, as opposed to a locoregional flap. A large retrospective study on only T3 and T4 category oral cancers, 31 however, showed a significant decrease in the rate of PM (from 18% to 7%) after the introduction of routine free flap reconstruction.…”

“…The availability of frozen sections during the surgical resection of HNSCC could theoretically lower the rate of PM, but there is conflicting evidence in the literature that neither supports nor refutes this relationship. 12 The availability of a reconstructive surgeon, with the ability to perform microvascular free flap reconstruction, is another potential factor that can influence margin status. It can be hypothesized that the availability of microvascular free tissue transfer allows for a more aggressive tumor resection to achieve clear margins, despite the potential creation of extensive functional and cosmetic defects.…”

Randomized controlled trial of a multisite speech pathology telepractice service providing swallowing and communication intervention to patients with head and neck cancer: Evaluation of service outcomes

“…It is widely considered best practice for patients with head and neck cancer to be treated at high‐volume specialist cancer centers supported by an expert multidisciplinary team . Speech pathologists are integral members of the head and neck cancer team and specialize in the assessment, management, and rehabilitation of swallowing and communication disorders.…”

“…It is widely considered best practice for patients with head and neck cancer to be treated at high-volume specialist cancer centers supported by an expert multidisciplinary team. [1][2][3] Speech pathologists are integral members of the head and neck cancer team and specialize in the assessment, management, and rehabilitation of swallowing and communication disorders. Because of the complex nature of these deficits, expertise in a wide range of specialist clinical tasks is required [4][5][6][7][8][9][10][11][12][13][14][15] to provide prompt and accurate intervention that minimizes medical complications and optimizes functional outcomes.…”

Positive Surgical Margins in Submandibular Malignancies: Facility and Practice Variation

“…18,19 Available literature indicates positive margins in salivary cancer are independently associated with worse locoregional control and survival. 11,[20][21][22][23][24][25] While clinical and institutional factors predictive of positive margins have been analyzed in other HNC sites, [26][27][28] including the parotid gland, 29 little is known about positive margins in submandibular malignancies.…”