Abstract
BackgroundInadequate resection margins in oral cavity squamous cell carcinoma have an adverse effect on patient outcome. Intraoperative assessment provides immediate feedback enabling the surgeon to achieve adequate resection margins. The goal of this study was to evaluate the value of specimen-driven intraoperative assessment by comparing the margin status in the period before and the period after the introduction of specimen-driven assessment as a standard of care (period 2010–2012 vs period 2013–2017).MethodsA cohort of patients surgically treated for oral squamous cell carcinoma at the Erasmus MC Cancer Institute, Rotterdam, between 2010–2012 was studied retrospectively and compared to results of a prospectively collected cohort between 2013–2017. The frequency, type and results of intraoperative assessment of resection margins were analyzed.ResultsOne hundred seventy-four patients were included from 2010–2012, 241 patients were included from 2013–2017. An increase in the frequency of specimen-driven assessment was seen between the two periods, from 5% in 2010–2012 to 34% in 2013–2017. When performing specimen-driven assessment, 16% tumor-positive resection margins were found in 2013–2017, compared to 43% tumor-positive resection margins overall in 2010–2012. We found a significant reduction of inadequate resection margins for specimen-driven intraoperative assessment (p < 0.001). Also, tumor recurrence significantly decreased, and disease-specific survival improved when performing specimen-driven intraoperative assessment.ConclusionsSpecimen-driven intraoperative assessment improves resection margins and consequently, the outcome of oral cancer patients. We advocate this method as standard of care.
Highlights
Patients with inadequate tumor resection margins often receive adjuvant treatment, which leads to higher morbidity [1].inadequate resection margins in oral cavity squamous cell carcinoma (OCSCC) lead to a significantly worse clinical outcome [2,3,4].In our previous retrospective study, we found inadequate resection margins in 85% of OCSCC cases based on final histopathology [3]
We found a significant reduction of inadequate resection margins for specimen-driven intraoperative assessment (p < 0.001)
This study aimed to evaluate the value of specimen-driven intraoperative assessment by comparing the margin status in the period before and the period after the introduction of specimendriven assessment
Summary
Patients with inadequate tumor resection margins often receive adjuvant treatment (radiotherapy, chemoradiation and/or reoperation), which leads to higher morbidity [1].inadequate resection margins in oral cavity squamous cell carcinoma (OCSCC) lead to a significantly worse clinical outcome [2,3,4].In our previous retrospective study, we found inadequate resection margins (i.e., a distance of ≤5 mm from tumor border to resection surface) in 85% of OCSCC cases based on final histopathology [3]. In order to control resection margins, intraoperative assessment by frozen sectionprocedure is available During this procedure, the surgeon samples tissue from seemingly the most suspicious areas in the wound bed (i.e., the defect-driven intraoperative assessment). For the detection of inadequate margins during OCSCC surgery, this defect-driven frozen section procedure has been shown to have low sensitivity [5,6,7,8,9]. This procedure is time-consuming and only a limited number of tissue samples can be examined, leading to sampling error, and resulting in underestimation of inadequate margins [10,11,12,13,14,15]. The goal of this study was to evaluate the value of specimen-driven intraoperative assessment by comparing the margin status in the period before and the period after the introduction of specimen-driven assessment as a standard of care (period 2010–2012 vs period 2013–2017)
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