Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study.

Cornelia G.F Van Lanschot,Tom C Bakker Schut,Cees A Meeuwis,Robert J Baatenburg De Jong,Martine F Van Der Kamp,Hetty Mast,Geert J.L.H Van Leenders,Senada Koljenović,Froukje L.J Cals,Vincent Noordhoek Hegt,Rob Verdijk,Dominiek Monserez,Ivo Ten Hove,Roeland W.H Smits,Aniel Sewnaik,Gerwin J Puppels,Elisa M Barroso,Jose A Hardillo

doi:10.1002/hed.25690

Abstract

BackgroundSpecimen‐driven intraoperative assessment of the resection margins provides immediate feedback if an additional excision is needed. However, relocation of an inadequate margin in the wound bed has shown to be difficult. The objective of this study is to assess a reliable method for accurate relocation of inadequate tumor resection margins in the wound bed after intraoperative assessment of the specimen.MethodsDuring oral cavity cancer surgery, the surgeon placed numbered tags on both sides of the resection line in a pair‐wise manner. After resection, one tag of each pair remained on the specimen and the other tag in the wound bed. Upon detection of an inadequate margin in the specimen, the tags were used to relocate this margin in the wound bed.ResultsThe method was applied during 80 resections for oral cavity cancer. In 31 resections an inadequate margin was detected, and based on the paired tagging an accurate additional resection was achieved.ConclusionPaired tagging facilitates a reliable relocation of inadequate margins, enabling an accurate additional resection during the initial surgery.

Highlights

Surgery is one of the main treatment modalities for oral cavity cancer
Intraoperative assessment of the resection margins is only meaningful if an accurate additional resection is enabled
McIntosh et al described that intraoperative control of the resection margins is more frequently performed in head and neck surgery than in other surgical specialties.[7]

Summary

Introduction

Surgery is one of the main treatment modalities for oral cavity cancer. The goal is complete tumor removal withOral presentation: July 2016, 9th International Conference on Head and Neck Cancer adequate resection margins (i.e. more than 5 mm of healthy tissue between tumor border and resection surface).[1]. Surgery is one of the main treatment modalities for oral cavity cancer. Relocation of an inadequate margin in the wound bed has shown to be difficult. The objective of this study is to assess a reliable method for accurate relocation of inadequate tumor resection margins in the wound bed after intraoperative assessment of the specimen. Methods: During oral cavity cancer surgery, the surgeon placed numbered tags on both sides of the resection line in a pair-wise manner. Upon detection of an inadequate margin in the specimen, the tags were used to relocate this margin in the wound bed. In 31 resections an inadequate margin was detected, and based on the paired tagging an accurate additional resection was achieved. Conclusion: Paired tagging facilitates a reliable relocation of inadequate margins, enabling an accurate additional resection during the initial surgery

Objectives

Methods

Results

Conclusion