Positive Surgical Margins in Early Stage Oral Cavity Cancer: An Analysis of 20,602 Cases

Luryi, Alexander L.; Chen, Michelle; Mehra, Saral; Roman, Sanziana A.; Sosa, Julie Ann; Judson, Benjamin L.

doi:10.1177/0194599814551718

Cited by 73 publications

(114 citation statements)

References 25 publications

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“…12 We also added total intraoperative intravenous fluids, which has been associated with postoperative respiratory complications. 13,14 To obtain more detailed surgical information, we added the type of reconstruction and donor site closure details.…”

Section: Resultsmentioning

confidence: 99%

Development and Feasibility of a Specialty-Specific National Surgical Quality Improvement Program (NSQIP)

Lewis

Aloia

Shi

et al. 2016

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) serves the need for continual quality assessment in general surgery. Previously, no parallel mechanism specific to head and neck oncologic surgery existed. OBJECTIVE To address the need for continual quality assessment in subspecialty surgery by adapting the ACS NSQIP platform for complex head and neck oncologic surgical procedures. DESIGN, SETTING, AND PARTICIPANTS With an institutional ACS NSQIP team’s guidance, surgeons from the departments of head and neck surgery and plastic and reconstructive surgery developed disease- and procedure-specific preoperative, intraoperative, and postoperative variables specific to head and neck surgery requiring reconstruction. Collection occurred with 100% sampling and standard ACS NSQIP 30-day follow-up. After a pilot period, long-term functional outcomes were added to this platform. A total of 312 patients underwent head and neck surgery requiring reconstruction at an academic medical center between August 1, 2012, and June 30, 2013. EXPOSURES Development of a specialty-specific head and neck surgery ACS NSQIP platform. MAIN OUTCOMES AND MEASURES The feasibility of adapting the ACS NSQIP platform to capture complex head and neck surgery metrics in all patients. RESULTS Head and neck surgery–specific preoperative, intraoperative, and postoperative variables were added to the ACS NSQIP platform and evaluated in 312 patients (201 [64.4%] male). Only 42 patients (13.5%) had no preoperative risk factors, and 136 (43.6%) had 3 or more risk factors. The mean (SD) duration of operation was 9.4 (3.0) hours (range, 1.7–19.3 hours). The mean (SD) postoperative length of stay was 7.9 (4.7) days (range, 1–40 days), 58 patients (18.6%) had an unplanned return to the operating room, 23 patients (7.4%) were readmitted within 30 days, and 3 patients (1.0%) died within 30 days. More than half of the patients (160 [51.3%]) did not experience a postoperative occurrence. CONCLUSIONS AND RELEVANCE To our knowledge, this is the first comprehensive complex oncologic surgery outcomes platform derived from ACS NSQIP methods. The initial pilot demonstrates the ability to systematically capture head and neck surgery–specific variables with complete sampling. With multi-institutional expansion, increased accrual, and long-term patient-reported outcomes, we hope to set risk-adjusted benchmarks that may underpin quality improvement efforts in complex head and neck surgery.

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Section: Resultsmentioning

confidence: 99%

Development and Feasibility of a Specialty-Specific National Surgical Quality Improvement Program (NSQIP)

Lewis

Aloia

Shi

et al. 2016

JAMA Otolaryngol Head Neck Surg

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“…This association was attributed to the hospital and surgeon's experience which yielded improved rates of achieving negative margins (6)(7)(8) and higher rates of dissecting involved lymph nodes (6,9,10). However, there is limited data about whether this volume effect exists in radiation-treated cancer patients (11), and whether treatment at a radiation facility that treats a high case volume of cancer patients is associated with improved survival (12).…”

Section: Introductionmentioning

confidence: 99%

Association Between Treatment at a High-Volume Facility and Improved Survival for Radiation-Treated Men With High-Risk Prostate Cancer

Chen

Mahal

Muralidhar

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…The literature is clear that in order to maximize survival, reduce recurrence, and improve quality of life for patients undergoing oncologic head and neck surgery, negative margins are paramount [10][11][12][13][14] . In fact, positive margin rates are associated with tremendous variability and have been postulated as a useful quality measure for early oral cavity cancer therapy [15] . Therefore while the goal of modern oncologic surgery is to achieve a true negative margin resection, this goal is currently hampered by significant technical limitations in margin evaluation.…”

Section: Reviewmentioning

confidence: 99%

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

Miles

2016

Cancer Cell Microenviron

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The quest for negative margins during head and neck oncologic surgery continues to challenge surgeons worldwide. Current technological advances offer significant promise to advance the field and improve operative margin detection. This review focuses on current optical technology, which has been evaluated for intraoperative margin control in head and neck oncologic surgery. Many of the current systems have technical limitations and there is no current standard technology being applied in the field of head and neck oncology to enhance intraoperative margin control. Surgeons continue to rely on intraoperative frozen section analysis, however many optical systems have shown high rates of sensitivity and specificity when discriminating benign from malignant tissue. These technologies shows significant promise for intraoperative margin control and may be enhanced by targeted molecular imaging, or spectral analysis, in the future. Translational trials are rare and are the key to the path of independence from frozen section analysis.

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Positive Surgical Margins in Early Stage Oral Cavity Cancer: An Analysis of 20,602 Cases

Cited by 73 publications

References 25 publications

Development and Feasibility of a Specialty-Specific National Surgical Quality Improvement Program (NSQIP)

Development and Feasibility of a Specialty-Specific National Surgical Quality Improvement Program (NSQIP)

Association Between Treatment at a High-Volume Facility and Improved Survival for Radiation-Treated Men With High-Risk Prostate Cancer

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

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