Close Resection Margins Do Not Influence Local Recurrence in Patients With Oral Squamous Cell Carcinoma: A Prospective Cohort Study

Abstract

This study investigated the clinical relevance of the distance between the resection margin and tumor cells of the primary sites for oral squamous cell carcinoma, with particular attention to local recurrence rate. All patients diagnosed with oral squamous cell carcinoma from 1995 to 2006 and treated primarily with surgery formed the initial cohort of the study. Patient with various degrees of dysplasia in the margin, patients who received radiotherapy, and patients who died of causes other than oral cancer were excluded. Margins 1 to 5mm were considered close. A margin of at least 5mm was considered free of disease (clear). Local recurrence was defined as tumor development at the site of the primary tumor during the follow-up period (≥5yr). The Fisher exact test was used to determine the relevance of the differences between the studied groups (free vs close margins) in relation to local recurrence. Histologic analysis of the specimens was performed. Of the 53 patients, 32 had free margins and 3 of the 32 had a local recurrence. In addition, 21 patients had close margins and 3 of the 21 had a local recurrence. The difference between the 2 groups was not statistically relevant. The authors advocate that the strategy of using close resection margins as a generic indicator for local recurrence and adverse prognosis might have to be reassessed. The histopathologic evidence of tumor cells within a distance less than 0.5cm from the surgical margins does not necessarily seem to offer a certain indication for additional treatment. Other prognostic factors, such as involvement of cervical lymph nodes and tumor depth, must be considered in the decision making for further treatment.