The clinical significance of pathological findings in surgically resected margins of the primary tumor in head and neck carcinoma

Prognostic Indicators in Head and Neck Oncology Including the New 7th Edition of the AJCC Staging System

“…Similarly, we found no significant differences in locoregional recurrence between patient groups for negative (28/119, or 23.5%) and close margins (\5 mm, 4/30 or 13%), after the exclusion of 19 patients with frankly positive (''cut through'') margins [25]. The local recurrence rates for patients with inadequate margins in these two studies [25,33] are better than for the corresponding inadequate margin groups in the previous studies [28,29], although the same 5 mm margin standard was used. Why would some ''inadequate'' resection margins be associated with better outcome than others?…”

“…This would be seen as a lack of significant difference in outcome between patients with adequate and inadequate margins. We speculate that the degree of margin ''inadequacy'' was underestimated in the studies by Chen, Loree, and Garzino, which is reflected as significantly poorer outcomes for these patients [28][29][30]. Testing this hypothesis requires a well-designed multicenter study, ideally limited to one anatomic site, which would be adequately powered to adjust for the many anticipated confounders.…”

“…Using the definition of ''tumor cut-through'' for positive margins, Byers [27] reported on 216 patients, and demonstrated local recurrence rates of 80% in the positive margin group, compared to 12-18% in the negative margin group. The definition of C5 mm for margin adequacy is a common standard, and was used in the following statistically significant studies [28][29][30][31]. Chen reported on 270 patients and demonstrated locoregional recurrence of 55 versus 17%, and 5-year disease-free survival of 7 versus 39%, for inadequate, versus negative margin groups, respectively [28].…”

“…The definition of C5 mm for margin adequacy is a common standard, and was used in the following statistically significant studies [28][29][30][31]. Chen reported on 270 patients and demonstrated locoregional recurrence of 55 versus 17%, and 5-year disease-free survival of 7 versus 39%, for inadequate, versus negative margin groups, respectively [28]. Loree reported on 303 patients and demonstrated locoregional recurrence of 30 versus 18%, and 5-year overall survival of 52 versus 60%, for inadequate, versus negative margin groups, respectively [29].…”

Prognostic Value of Frozen Section in T1, T2 Carcinoma of Oral Cavity

“…Among 12 patients who underwent excision of involved margin under frozen section control 11 (12.2 %) patients were identified in frozen section and one patient was revised by clinical judgment immediately after excision, four patients were revised due to false interpretation of margin as ''involved'' in frozen section. Chen et al [15] reported 100 % local recurrence in positive margins and 17 % in negative margins. The outcome of positive margins on further therapy reported by Binahmed et al [10] suggests that the patients with positive margins did not significantly benefit from radiotherapy alone and recurrences among them were greater than the patients with initial clear margins, kovacs et al has reported better survival rates with chemo radiotherapy in such instances [16].…”