Intraoperative Assessment of the Resection Specimen Facilitates Achievement of Adequate Margins in Oral Carcinoma

Abstract

BackgroundInadequate resection margins in oral cavity squamous cell carcinoma have an adverse effect on patient outcome. Intraoperative assessment provides immediate feedback enabling the surgeon to achieve adequate resection margins. The goal of this study was to evaluate the value of specimen-driven intraoperative assessment by comparing the margin status in the period before and the period after the introduction of specimen-driven assessment as a standard of care (period 2010–2012 vs period 2013–2017).MethodsA cohort of patients surgically treated for oral squamous cell carcinoma at the Erasmus MC Cancer Institute, Rotterdam, between 2010–2012 was studied retrospectively and compared to results of a prospectively collected cohort between 2013–2017. The frequency, type and results of intraoperative assessment of resection margins were analyzed.ResultsOne hundred seventy-four patients were included from 2010–2012, 241 patients were included from 2013–2017. An increase in the frequency of specimen-driven assessment was seen between the two periods, from 5% in 2010–2012 to 34% in 2013–2017. When performing specimen-driven assessment, 16% tumor-positive resection margins were found in 2013–2017, compared to 43% tumor-positive resection margins overall in 2010–2012. We found a significant reduction of inadequate resection margins for specimen-driven intraoperative assessment (p < 0.001). Also, tumor recurrence significantly decreased, and disease-specific survival improved when performing specimen-driven intraoperative assessment.ConclusionsSpecimen-driven intraoperative assessment improves resection margins and consequently, the outcome of oral cancer patients. We advocate this method as standard of care.

Is the Depth of Invasion a Marker for Elective Neck Dissection in Early Oral Squamous Cell Carcinoma?

“…Moreover, for the old cohort the reliable data for LVI, PNI, tumor diameter and margin status were missing and therefore not further analyzed and compared with the newer cohort. Finally, the patient outcome (locoregional recurrence and survival) in the previously published study may be influenced by the fact that our institute started with intra-operative assessment of resection margins in 2013 (22,37,38).…”

Salvage surgery for patients with residual/persistent diseases after improper or insufficient treatment of oral squamous cell carcinoma: can we rectify these mistakes?

“…In literature, such "recurrences" were only divided by years, as either rapid or late recurrences, irrespective of detailed previous primary treatment [14,[17][18][19]. As far as we are concerned, initial treatment modalities, prior surgical margin and postsurgical symptom (pain) should all be taken into consideration when differentiating true "recurrent" and "residual/persistent" OSCCs, as some "recurrences" were in fact residual/persistent lesions (with evidence of residual diseases or without intermittent remission of symptoms) [13]. We figure that these OSCCs become residual due more to improper initial treatment or insufficient resections, rather than to oncological aggressiveness of OSCCs.…”

“…Due to such varied negligences in primary treatment, we call for strictly adhering to the treatment and diagnosis guidelines otherwise it may cause tremendous disaster to the patients. Conversely, improper management for OSCC will cause locoregional failure and even death [11][12][13]. The preoperative plan including surgical approach, reconstructive method and adjuvant therapy of oral cancer needs a multidisciplinary team to achieve the best clinical outcomes.…”

“…The philosophy behind such insistence was primarily established on the sole concern with margin positivity, irrespective of several other clinicopathologic factors, such as history of adjuvant therapy (blurring true margins), accuracy of margin assessment (specimen-driven or tumor-bed driven), number of margins, times of secondary negative margins (i.e. initially positive margins), tumor sizes, infiltrative depths and extirpation routes (surgical exposure) [2,[10][11][12][13]. Therefore, without scrutinizing prior surgical procedures, in our opinion, it is probably a bit far-fetched to assigning local surgical failures of heterogenous causes into one single category of recurrence, especially for patients who "recur" rapidly within just weeks after primary surgical resections.…”

A Systematic Review of Oral Biopsies, Sample Types, and Detection Techniques Applied in Relation to Oral Cancer Detection

“…The following supporting information can be downloaded at: , Table S1: Summary characteristics of included studies [ 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 , 205 , 206 , 207 , 208 , 209 , 210 , 211 , 212 , 213 , 214 , 215 , 216 , 217 , 218 , 219 , 220 , 221 , 222 , 223 , 224 , 225 , 226 , 227 , 228 , 229 , 230 , 231 , 232 , 233 , 234 , 235 , 236 , 237 , 238 , 239 , 240 , 241 , 242 <...…”