How Does the Close Surgical Margin Impact Recurrence and Survival When Treating Oral Squamous Cell Carcinoma?

doi:10.1016/j.joms.2014.12.014

Journal of Oral and Maxillofacial Surgery

Volume 73, Issue 6, June 2015, Pages 1182-1188

Presented at the Poster Session at the American Association of Oral and Maxillofacial Surgeons Annual Meeting; October 2013.

https://doi.org/10.1016/j.joms.2014.12.014 Get rights and content

Purpose

The surgical margin is the main prognostic factor over which the surgeon has control during resection of oral squamous cell carcinoma (OSCC). This study examined the association between surgical excision margins of patients with OSCC and outcomes of disease-free and overall survival.

Materials and Methods

The authors implemented a retrospective cohort study. The sample was composed of patients with OSCC having resection as their initial treatment. The predictor variable was the pathologic surgical margin, defined as clear (>5 mm), close (1 to 5 mm), or involved (<1 mm). The outcome variables were disease-free (absence of locoregional recurrence) and overall survival. Data were analyzed using Kaplan-Meier survival curves and Cox regression hazard model.

Results

The sample was composed of 54 patients with a mean age of 60.5 years (range, 19 to 85 yr) and 26% were women. The 2- and 5-year overall survival rates were 59 and 50%, respectively. The clear surgical margin group showed higher disease-free survival rates than patients with close and involved margins (5-yr probability, 0.78 vs 0.43 and 0.29; P = .014) and a trend toward increased overall survival at 2 and 5 years (P = .093).

Conclusion

The results suggest that the presence of a close surgical margin (1 to 5 mm) is an adverse risk feature comparable to an involved margin and therefore is associated with decreased disease-free and overall survival. Future studies are needed to replicate these findings before they can be used as a basis for clinical recommendations.

Section snippets

Study Design and Sample

This was a retrospective cohort study approved by the institutional review board. The study sample was derived from a population of patients who presented to Harborview Medical Center or the University of Washington Medical Center in Seattle for evaluation and management of OSCC from July 1, 1995 through July 31, 2012. Patients eligible for study inclusion received no previous treatment for their OSCC, received no prior radiation or chemotherapy, underwent tumor resection as their primary

Characteristics of Patients

In total, 174 patients with OSCC were treated with resective surgery at the University of Washington Medical Center or Harborview Medical Center from July 1995 through July 2012. Of those, 54 met the study's inclusion criteria, resulting in a cohort of 14 female and 40 male patients. The mean age was 60.5 years (standard deviation, 14.3 yr; range, 19 to 85 yr). Seven patients had stage 1 (13%), 18 had stage 2 (33%), 3 had stage 3 (6%), and 26 had stage 4 (48%) disease based on the pathologic

Discussion

The purpose of this study was to examine the association between surgical excision margins of patients with OSCC and outcomes of disease-free survival (absence of locoregional recurrence) and overall survival. The authors hypothesized that a close surgical margin would decrease the likelihood of disease-free survival. The specific aims were 2-fold: 1) define the impact a close surgical margin has on locoregional recurrence and overall survival and 2) identify important prognostic indicators

Acknowledgments

The authors thank Dr Rachael T. Smoot for her work consolidating the cancer cases of the head and neck surgeons.

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Radiographic tumor volume (RTV) of oral squamous cell carcinoma (SCC) is seldom measured in practice. Aims of the study are to estimate RTV of SCC and to investigate its relationship with clinical and pathological stage, tumor margin status, recurrence, and need for chemo/radiation.
The design is a retrospective cohort study. The predictor variable is SCC RTV. The primary outcome variables are clinical and pathological tumor size. The secondary outcomes are margin status and postoperative chemo/radiation. Tumor dimensions were measured on preoperative maxillofacial or neck computer tomography images with contrast. Information on patient and tumor characteristics was obtained. Pearson correlation, t test, ANOVA and log rank test were used for statistical analysis. The significance level was set at .05.
Thirty-six subjects aged 36 to 86 were included in the study. Positive association was found between clinical T stage and RTV (P = .0003) and between pathologic T stage and RTV (P = .002). Mean value of RTV was significantly higher in the group with positive margins (P = .0004). RTV was significantly higher in cancers requiring adjuvant chemo/radiation (P = .033). Mean RTV for patients with recurrence was 1.86 cm³ as compared to 1.29 cm³ for patients with no recurrence. Higher tumor volumes were more likely to be associated with recurrence.
RTV is a variable that is readily available to head and neck surgeons. RTV is associated with clinical and pathological tumor sizes, margin status, need for adjuvant chemo/radiation and tumor recurrence.
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This study reports on the effects of insertion velocity, needle tip geometry and needle diameter on tissue deformation and maximum insertion force. Moreover, the effect of multiple insertions with the same needle on the maximum insertion force is reported. The tissue deformation and maximum insertion force strongly depend on the insertion velocity and the tip geometry. No correlation was found between the outer diameter and the maximum insertion force for small needles (30G – 32G). The endurance experiments showed no remarkable difference in the maximum insertion force during 100 insertions.
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The aim of this study was to evaluate and present an automated method for registration of magnetic resonance imaging (MRI) and computed tomography (CT) or cone beam CT (CBCT) images of the mandibular region for patients with oral squamous cell carcinoma (OSCC). Registered MRI and (CB)CT could facilitate the three-dimensional virtual planning of surgical guides employed for resection and reconstruction in patients with OSCC with mandibular invasion. MRI and (CB)CT images were collected retrospectively from 19 patients. MRI images were aligned with (CB)CT images employing a rigid registration approach (stage 1), a rigid registration approach using a mandibular mask (stage 2), and two non-rigid registration approaches (stage 3). Registration accuracy was quantified by the mean target registration error (mTRE), calculated over a set of landmarks annotated by two observers. Stage 2 achieved the best registration result, with an mTRE of 2.5 ± 0.7 mm, which was comparable to the inter- and intra-observer variabilities of landmark placement in MRI. Stage 2 was significantly better aligned compared to all approaches in stage 3. In conclusion, this study demonstrated that rigid registration with the use of a mask is an appropriate image registration method for aligning MRI and (CB)CT images of the mandibular region in patients with OSCC.
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The main challenge for radical resection in oral cancer surgery is to obtain adequate resection margins. Especially the deep margin, which can only be estimated based on palpation during surgery, is often reported inadequate. To increase the percentage of radical resections, there is a need for a quick, easy, minimal invasive method, which assesses the deep resection margin without interrupting or prolonging surgery. This systematic review provides an overview of technologies that are currently being studied with the aim of fulfilling this demand.
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At the moment, the most prevailing technique remains frozen section analysis. In the search for other assessment methods to evaluate the deep resection margin, some technologies are very promising for future use when effectiveness has been shown in larger trials, e.g., fluorescence (real-time, sampling depth up to 6 mm) or optical techniques such as hyperspectral imaging (real-time, sampling depth few mm) for microscopic margin assessment and ultrasound (less than 10 min, sampling depth several cm) for assessment on a macroscopic scale.
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Oral cancer (OC) is a neoplastic process of the oral cavity that has high mortality and significant effects on patients’ aesthetics. The majority of OC is oral squamous cell carcinoma (OSCC) and resection remains the most frequent treatment. Recurrence is the main cause of tumor-related mortality.
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: Conflict of Interest Disclosures: None of the authors reported any disclosures.

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Surgical oncology and reconstructionHow Does the Close Surgical Margin Impact Recurrence and Survival When Treating Oral Squamous Cell Carcinoma?

Purpose

Materials and Methods

Results

Conclusion

Section snippets

Study Design and Sample

Characteristics of Patients

Discussion

Acknowledgments

Oral Oncol

Int J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Oral Oncol

Br J Oral Maxillofac Surg

J Craniomaxillofac Surg

Oral Oncol

Int J Radiat Oncol Biol Phys

Quantification of surgical margin shrinkage in the oral cavity

Head Neck

Surgical oncology and reconstruction
How Does the Close Surgical Margin Impact Recurrence and Survival When Treating Oral Squamous Cell Carcinoma?