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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2017

01-06-2017 | Head and Neck Oncology

Differential Impact of Close Surgical Margin on Local Recurrence According to Primary Tumor Size in Oral Squamous Cell Carcinoma

Authors: Jeon Yeob Jang, MD, PhD, Nayeon Choi, MD, Young-Hyeh Ko, MD, PhD, Man Ki Chung, MD, PhD, Young-Ik Son, MD, PhD, Chung-Hwan Baek, MD, PhD, Kwan-Hyuck Baek, PhD, Han-Sin Jeong, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2017

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Abstract

Background

The extent of surgical safety margin (gross tumor border to resection margin) in oral cancer surgery remains unclear, and no study has determined the differential impact of close surgical margin and microscopic extension according to primary tumor size in oral cancers.

Methods

We retrospectively analyzed the clinical data of 325 patients with surgically treated oral cavity squamous cell carcinomas to determine the effect of a close surgical margin (<5 mm) (cSM5) on local recurrence. In addition, the depth of microscopic tumor infiltration was determined in 90 available surgical specimens.

Results

The cSM5 was not related to the risk of local tumor recurrence in early-stage oral cancer, while it significantly increased the rate of local tumor recurrence in resectable advanced-stage oral cancers (hazard ratio 3.157, 95 % confidence interval 1.050–9.407, p = 0.041). Addition of postoperative adjuvant radiation to early-stage tumors with cSM5 did not further reduce the local recurrence rate compared to surgery alone. The depth of microscopic tumor extension from the gross tumor border was significantly associated with primary tumor thickness (ρ = 0.390, p < 0.001) and tumor sizes (ρ = 0.308, p = 0.003), which was a median (range) of 0.84 (0.14–2.32) mm in T1, 1.06 (0.20–4.34) mm in T2, and 1.77 (0.13–4.70) mm in T3–4.

Conclusions

The cSM5 was a significant risk factor for local recurrence only in advanced oral cancers, but not in early-stage tumors, where microscopic tumor extension was not beyond 3 mm in T1 tumors. Thus, the extent of surgical safety margin can be redefined according to the primary tumor size.
Appendix
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Literature
1.
2.
3.
Shah JP, Gil Z. Current concepts in management of oral cancer—surgery. Oral Oncol. 2009;45:394–401.CrossRefPubMed
4.
Brennan JA, Mao L, Hruban RH, et al. Molecular assessment of histopathological staging in squamous-cell carcinoma of the head and neck. N Engl J Med. 1995;332:429–35.CrossRefPubMed
5.
Nicoletti G, Soutar DS, Jackson MS, Wrench AA, Robertson G. Chewing and swallowing after surgical treatment for oral cancer: functional evaluation in 196 selected cases. Plast Reconstr Surg. 2004;114:329–38.CrossRefPubMed
6.
Hara I, Gellrich NC, Duker J, et al. Evaluation of swallowing function after intraoral soft tissue reconstruction with microvascular free flaps. Int J Oral Maxillofac Surg. 2003;32:593–9.CrossRefPubMed
7.
Hinni ML, Ferlito A, Brandwein-Gensler MS, et al. Surgical margins in head and neck cancer: a contemporary review. Head Neck. 2013;35:1362–70.CrossRefPubMed
8.
Mao L, Clark D. Molecular margin of surgical resections—where do we go from here? Cancer. 2015;121:1914–6.CrossRefPubMed
9.
Meier JD, Oliver DA, Varvares MA. 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. 2005;27:952–8.CrossRefPubMed
10.
Binahmed A, Nason RW, Abdoh AA. The clinical significance of the positive surgical margin in oral cancer. Oral Oncol. 2007;43:780–4.CrossRefPubMed
11.
Sutton DN, Brown JS, Rogers SN, Vaughan ED, Woolgar JA. The prognostic implications of the surgical margin in oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2003;32:30–4.CrossRefPubMed
12.
Kurita H, Nakanishi Y, Nishizawa R, et al. Impact of different surgical margin conditions on local recurrence of oral squamous cell carcinoma. Oral Oncol. 2010;46:814–7.CrossRefPubMed
13.
Chen TC, Wang CP, Ko JY, Yang TL, Lou PJ. The impact of pathologic close margin on the survival of patients with early stage oral squamous cell carcinoma. Oral Oncol. 2012;48:623–8.CrossRefPubMed
14.
Barry CP, Ahmed F, Rogers SN, et al. Influence of surgical margins on local recurrence in T1/T2 oral squamous cell carcinoma. Head Neck. 2015;37:1176–80.CrossRefPubMed
15.
Dik EA, Willems SM, Ipenburg NA, Adriaansens SO, Rosenberg AJ, van Es RJ. Resection of early oral squamous cell carcinoma with positive or close margins: relevance of adjuvant treatment in relation to local recurrence: margins of 3 mm as safe as 5 mm. Oral Oncol. 2014;50:611–5.CrossRefPubMed
16.
Ch’ng S, Corbett-Burns S, Stanton N, et al.2013 Close margin alone does not warrant postoperative adjuvant radiotherapy in oral squamous cell carcinoma. Cancer.119(13):2427–37.CrossRefPubMed
17.
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.CrossRefPubMed
18.
Pfister DG, Ang KK, Brizel DM, et al. Head and neck cancers. J Natl Compr Canc Netw. 2011;9:596–650.CrossRefPubMed
19.
Mistry RC, Qureshi SS, Kumaran C. Post-resection mucosal margin shrinkage in oral cancer: quantification and significance. J Surg Oncol. 2005;91:131–3.CrossRefPubMed
20.
Lee J, Yoon N, Choi SY, et al. Extent of local invasion and safe resection in cT1–2 tonsil cancer. J Surg Oncol. 2013;107:469–73.CrossRefPubMed
21.
Yang TL, Wang CP, Ko JY, Lin CF, Lou PJ. Association of tumor satellite distance with prognosis and contralateral neck recurrence of tongue squamous cell carcinoma. Head Neck. 2008;30:631–8.CrossRefPubMed
22.
Hayashi M, Wu G, Roh JL, et al. Correlation of gene methylation in surgical margin imprints with locoregional recurrence in head and neck squamous cell carcinoma. Cancer. 2015;121:1957–65.CrossRefPubMedPubMedCentral
23.
de Carvalho AC, Kowalski LP, Campos AH, Soares FA, Carvalho AL, Vettore AL. Clinical significance of molecular alterations in histologically negative surgical margins of head and neck cancer patients. Oral Oncol. 2012;48:240–8.CrossRefPubMed
Metadata
Title
Differential Impact of Close Surgical Margin on Local Recurrence According to Primary Tumor Size in Oral Squamous Cell Carcinoma
Authors
Jeon Yeob Jang, MD, PhD
Nayeon Choi, MD
Young-Hyeh Ko, MD, PhD
Man Ki Chung, MD, PhD
Young-Ik Son, MD, PhD
Chung-Hwan Baek, MD, PhD
Kwan-Hyuck Baek, PhD
Han-Sin Jeong, MD, PhD
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5497-4

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