Top

Published in:

01-05-2018 | Review

Anatomical locations in the oral cavity where surgical resections of oral squamous cell carcinomas are associated with a close or positive margin—a retrospective study

Authors: Florian Alexander Kerker, Werner Adler, Kathrin Brunner, Tobias Moest, Matthias C. Wurm, Emeka Nkenke, Friedrich Wilhelm Neukam, Cornelius von Wilmowsky

Published in: Clinical Oral Investigations | Issue 4/2018

Abstract

Objectives

This study aimed to identify anatomical areas where resections of oral squamous cell carcinomas (OSCC) are significantly associated with close or positive margins.

Materials and methods

This retrospective study included 330 patients with a primary OSCC from 2010 to 2015. Patient and tumour data were categorised into three groups by R-status (R0 [clear], ≥ 5 mm, 185 patients [56.06%]; R1 [positive], < 1 mm, 24 patients [7.27%]; and R0 [close], 1–5 mm, 121 patients [36.67%]).

Results

Areas where resections were significantly associated with close or positive margins were the hard palate (p < 0.001), buccal mucosa (p = 0.03), floor of the mouth (p = 0.004), lower alveolar ridge (p = 0.01), retromolar triangle (p = 0.005), and dorsal tongue (p = 0.02).

Conclusions

Anatomical areas were identified in the oral cavity where it is challenging to resect OSCCs with an adequate safety margin.

Clinical relevance

These results may enable surgeons to achieve a postulated safe distance during tumour resection, leading to a survival benefit for patients.

Bagan JV, Scully C (2008) Recent advances in oral oncology 2007: epidemiology, aetiopathogenesis, diagnosis and prognostication. Oral Oncol 44(2):103–108. https://doi.org/10.1016/j.oraloncology.2008.01.008 CrossRefPubMed

Rivera C (2015) Essentials of oral cancer. Int J Clin Exp Pathol 8(9):11884–11894PubMedPubMedCentral

Shah JP, Gil Z (2009) Current concepts in management of oral cancer—surgery. Oral Oncol 45(4–5):394–401. https://doi.org/10.1016/j.oraloncology.2008.05.017 CrossRefPubMed

Ermer MA, Kirsch K, Bittermann G, Fretwurst T, Vach K, Metzger MC (2015) Recurrence rate and shift in histopathological differentiation of oral squamous cell carcinoma—a long-term retrospective study over a period of 13.5 years. J Craniomaxillofac Surg 43(7):1309–1313. https://doi.org/10.1016/j.jcms.2015.05.011 CrossRefPubMed

Black C, Marotti J, Zarovnaya E, Paydarfar J (2006) Critical evaluation of frozen section margins in head and neck cancer resections. Cancer 107(12):2792–2800. https://doi.org/10.1002/cncr.22347 CrossRefPubMed

Sutton DN, Brown JS, Rogers SN, Vaughan ED, Woolgar JA (2003) The prognostic implications of the surgical margin in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 32(1):30–34. https://doi.org/10.1054/ijom.2002.0313 CrossRefPubMed

Chen TY, Emrich LJ, Driscoll DL (1987) The clinical significance of pathological findings in surgically resected margins of the primary tumor in head and neck carcinoma. Int J Radiat Oncol Biol Phys 13(6):833–837CrossRef

Loree TR, Strong EW (1990) Significance of positive margins in oral cavity squamous carcinoma. Am J Surg 160(4):410–414CrossRef

Anderson CR, Sisson K, Moncrieff M (2015) A meta-analysis of margin size and local recurrence in oral squamous cell carcinoma. Oral Oncol 51(5):464–469. https://doi.org/10.1016/j.oraloncology.2015.01.015 CrossRefPubMed

10.

Ord RA, Aisner S (1997) Accuracy of frozen sections in assessing margins in oral cancer resection. J Oral Maxillofac Surg 55(7):663–669 discussion 669-671CrossRef

11.

Pfister DG, Ang KK, Brizel DM, Burtness BA, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Dunphy F, Eisele DW, Gilbert J, Gillison ML, Haddad RI, Haughey BH, Hicks WL Jr, Hitchcock YJ, Kies MS, Lydiatt WM, Maghami E, Martins R, McCaffrey T, Mittal BB, Pinto HA, Ridge JA, Samant S, Schuller DE, Shah JP, Spencer S, Weber RS, Wolf GT, Worden F, Yom SS, McMillian NR, Hughes M, National Comprehensive Cancer N (2013) Head and neck cancers, version 2.2013. Featured updates to the NCCN guidelines. J Natl Compr Cancer Netw 11(8):917–923CrossRef

12.

Shah JP, Cendon RA, Farr HW, Strong EW (1976) Carcinoma of the oral cavity: factors affecting treatment failure at the primary site and neck. Am J Surg 132(4):504–507CrossRef

13.

Spiro RH, Guillamondegui O Jr, Paulino AF, Huvos AG (1999) Pattern of invasion and margin assessment in patients with oral tongue cancer. Head Neck 21(5):408–413CrossRef

14.

Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M, European Organization for R, Treatment of Cancer T (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350(19):1945–1952. https://doi.org/10.1056/NEJMoa032641 CrossRefPubMed

15.

Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK, Radiation Therapy Oncology Group I (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944. https://doi.org/10.1056/NEJMoa032646 CrossRefPubMed

16.

Kessler P, Grabenbauer G, Leher A, Bloch-Birkholz A, Vairaktaris E, Neukam FW (2008) Neoadjuvant and adjuvant therapy in patients with oral squamous cell carcinoma: long-term survival in a prospective, non-randomized study. Br J Oral Maxillofac Surg 46(1):1–5. https://doi.org/10.1016/j.bjoms.2007.08.006 CrossRefPubMed

17.

Brown JS, Shaw RJ, Bekiroglu F, Rogers SN (2012) Systematic review of the current evidence in the use of postoperative radiotherapy for oral squamous cell carcinoma. Br J Oral Maxillofac Surg 50(6):481–489. https://doi.org/10.1016/j.bjoms.2011.08.014 CrossRefPubMed

18.

Amit M, Yen TC, Liao CT, Chaturvedi P, Agarwal JP, Kowalski LP, Ebrahimi A, Clark JR, Kreppel M, Zoller J, Fridman E, Bolzoni VA, Shah JP, Binenbaum Y, Patel SG, Gil Z, International Consortium for Outcome Research in H, Neck C (2013) Improvement in survival of patients with oral cavity squamous cell carcinoma: an international collaborative study. Cancer 119(24):4242–4248. https://doi.org/10.1002/cncr.28357 CrossRefPubMed

19.

Brandwein-Gensler M, Teixeira MS, Lewis CM, Lee B, Rolnitzky L, Hille JJ, Genden E, Urken ML, Wang BY (2005) Oral squamous cell carcinoma: histologic risk assessment, but not margin status, is strongly predictive of local disease-free and overall survival. Am J Surg Pathol 29(2):167–178CrossRef

20.

Meier JD, Oliver DA, Varvares MA (2005) Surgical margin determination in head and neck oncology: current clinical practice. The results of an international American Head and Neck Society Member Survey. Head Neck 27(11):952–958. https://doi.org/10.1002/hed.20269 CrossRefPubMed

21.

Johnson N FS, Ferlay J, et al. (2005) Squamous cell carcinoma. Barnes L, Eveson JW, Reichart P, et al eds, Pathology and genetics of head and neck tumours Lyon: IARC press;

22.

Helliwell DT, Woolgar DJ (2013) Standards and datasets for reporting cancers dataset for histopathology reporting of mucosal malignancies of the oral cavity. Royal college of Pathologist

23.

Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M (2002) AJCC cancer staging manual. Springer,

24.

Woolgar JA, Triantafyllou A (2005) A histopathological appraisal of surgical margins in oral and oropharyngeal cancer resection specimens. Oral Oncol 41(10):1034–1043. https://doi.org/10.1016/j.oraloncology.2005.06.008 CrossRefPubMed

25.

Batsakis JG (1999) Surgical excision margins: a pathologist’s perspective. Adv Anat Pathol 6(3):140–148CrossRef

26.

Cheng A, Cox D, Schmidt BL (2008) Oral squamous cell carcinoma margin discrepancy after resection and pathologic processing. J Oral Maxillofac Surg 66(3):523–529CrossRef

27.

El-Fol HA, Noman SA, Beheiri MG, Khalil AM, Kamel MM (2015) Significance of post-resection tissue shrinkage on surgical margins of oral squamous cell carcinoma. J Craniomaxillofac Surg 43(4):475–482. https://doi.org/10.1016/j.jcms.2015.01.009 CrossRefPubMed

28.

Johnson RE, Sigman JD, Funk GF, Robinson RA, Hoffman HT (1997) Quantification of surgical margin shrinkage in the oral cavity. Head Neck 19(4):281–286CrossRef

29.

Batsakis JG (2003) Clinical pathology of oral cancer. Oral Cancer Shah JP, Johnson NW, Batsakis JG:77–129

30.

Kolokythas A (2010) Long-term surgical complications in the oral cancer patient: a comprehensive review. Part I. J Oral Maxillofac Res 1(3):e1. https://doi.org/10.5037/jomr.2010.1301 CrossRefPubMedPubMedCentral

31.

Sundaram K, Schwartz J, Har-El G, Lucente F (2005) Carcinoma of the oropharynx: factors affecting outcome. Laryngoscope 115(9):1536–1542. https://doi.org/10.1097/01.mlg.0000175075.69706.64 CrossRefPubMed

32.

Ow TJ, Myers JN (2011) Current management of advanced resectable oral cavity squamous cell carcinoma. Clinical Experimental Otorhinolaryngology 4(1):1–10CrossRef

33.

DiNardo LJ, Lin J, Karageorge LS, Powers CN (2000) Accuracy, utility, and cost of frozen section margins in head and neck cancer surgery. Laryngoscope 110(10 Pt 1):1773–1776. https://doi.org/10.1097/00005537-200010000-00039 CrossRefPubMed

34.

Iseli TA, Lin MJ, Tsui A, Guiney A, Wiesenfeld D, Iseli CE (2012) Are wider surgical margins needed for early oral tongue cancer? J Laryngol Otol 126(3):289–294. https://doi.org/10.1017/S002221511100332X CrossRefPubMed

35.

Woolgar JA, Rogers S, West CR, Errington RD, Brown JS, Vaughan ED (1999) Survival and patterns of recurrence in 200 oral cancer patients treated by radical surgery and neck dissection. Oral Oncol 35(3):257–265CrossRef

36.

Licitra L, Mesía R, Keilholz U (2016) Individualised quality of life as a measure to guide treatment choices in squamous cell carcinoma of the head and neck. Oral Oncol 52:18–23CrossRef

37.

Bergeron M, Gauthier P, Audet N (2016) Decreasing loco-regional recurrence for oral cavity cancer with total Mohs margins technique. Journal of otolaryngology - head & neck surgery = Le Journal d’oto-rhino-laryngologie et de chirurgie cervico-faciale 45 (1):63. doi:https://doi.org/10.1186/s40463-016-0176-9

38.

Garavello W, Spreafico R, Somigliana E, Gaini L, Pignataro L, Gaini RM (2008) Prognostic influence of gender in patients with oral tongue cancer. Otolaryngol Head Neck Surg 138(6):768–771CrossRef

39.

Honorato J, Rebelo MS, Dias FL, Camisasca DR, Faria PA, Azevedo e Silva G, Lourenco SQ (2015) Gender differences in prognostic factors for oral cancer. Int J Oral Maxillofac Surg 44(10):1205–1211. https://doi.org/10.1016/j.ijom.2015.04.015 CrossRefPubMed

40.

Rosenthal EL, Warram JM, de Boer E, Chung TK, Korb ML, Brandwein-Gensler M, Strong TV, Schmalbach CE, Morlandt AB, Agarwal G, Hartman YE, Carroll WR, Richman JS, Clemons LK, Nabell LM, Zinn KR (2015) Safety and tumor specificity of cetuximab-IRDye800 for surgical navigation in head and neck cancer. Clinical Cancer Res : an Official J Am Assoc Cancer Res 21(16):3658–3666. https://doi.org/10.1158/1078-0432.ccr-14-3284 CrossRef

41.

Moore LS, Rosenthal EL, Chung TK, de Boer E, Patel N, Prince AC, Korb ML, Walsh EM, Young ES, Stevens TM (2017) Characterizing the utility and limitations of repurposing an open-field optical imaging device for fluorescence-guided surgery in head and neck cancer patients. J Nucl Med 58(2):246–251CrossRef

42.

Yarlagadda BB, Grillone GA (2015) Anatomic considerations in transoral robotic surgery. In: Robotic surgery of the head and neck. Springer, pp 13–27

43.

Yee S (2017) Transoral robotic surgery. AORN J 105(1):73–84CrossRef

44.

Nason RW, Binahmed A, Pathak KA, Abdoh AA, Sandor GK (2009) What is the adequate margin of surgical resection in oral cancer? Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Endodontics 107(5):625–629. https://doi.org/10.1016/j.tripleo.2008.11.013 CrossRefPubMed

Title: Anatomical locations in the oral cavity where surgical resections of oral squamous cell carcinomas are associated with a close or positive margin—a retrospective study
Authors: Florian Alexander Kerker
Werner Adler
Kathrin Brunner
Tobias Moest
Matthias C. Wurm
Emeka Nkenke
Friedrich Wilhelm Neukam
Cornelius von Wilmowsky
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 4/2018
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-018-2424-z

At a glance: The STEP trials

Springer Medicine

Anatomical locations in the oral cavity where surgical resections of oral squamous cell carcinomas are associated with a close or positive margin—a retrospective study

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 4/2018

Influence of a calcium hydroxide-based intracanal dressing on the quality of the root canal filling assessed by capillary flow porometry

How frequent does peri-implantitis occur? A systematic review and meta-analysis

Global oral health status of athletes with intellectual disabilities

X-ray diffraction analysis of MTA mixed and placed with various techniques

Oral cancer radiotherapy affects enamel microhardness and associated indentation pattern morphology

Effect of bleaching agent extracts on murine macrophages