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Auris Nasus Larynx. 2018 Aug 30. pii: S0385-8146(18)30539-X. doi: 10.1016/j.anl.2018.08.011. [Epub ahead of print]

Surgical margins in head and neck cancer: Intra- and postoperative considerations.

Author information

1
Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA. Electronic address: kthomasrobbins@gmail.com.
2
Liverpool Clinical Laboratories and School of Dentistry, University of Liverpool, Liverpool, UK.
3
Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.
4
Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, CIBERONC, Oviedo, Spain.
5
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
6
Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
7
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
8
International Head and Neck Scientific Group, Italy.
9
Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
10
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA.
11
Otorhinolaryngology-Head and Neck Surgery,Centro de Tratamento e Pesquisa Hospital do Cancer A.C. Camargo, São Paulo, Brazil.
12
University of Udine School of Medicine, Udine, Italy.
13
Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
14
Departments of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, UK.
15
Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
16
Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA.

Abstract

OBJECTIVE:

To provide a perspective on the significance of recent reports for optimizing cancer free surgical margins that have challenged standard practices.

METHODS:

We conducted a review of the recent literature (2012-2018) using the keywords surgical margin analysis, frozen and paraffin section techniques, head and neck cancer, spectroscopy and molecular markers.

RESULTS:

Of significance are the reports indicating superiority of tumor specimen directed sampling of margins compared to patient directed (tumor bed) sampling for frozen section control of oral cancers. With reference to optimal distance between tumor and the surgical margin, recent reports recommended cutoffs less than 5mm. Employment of new technologies such as light spectroscopy and molecular analysis of tissues, provide opportunities for a "real time" assessment of surgical margins.

CONCLUSIONS:

The commonly practiced method of patient directed margin sampling involving previous studies raises concern over conclusions made regarding the efficacy of frozen section margin control. The recent studies that challenge the optimal distance for clear surgical margins are retrospective and address patient cohorts with inherently confounding factors. The use of novel ancillary techniques require further refinements, clinical trial validation, and justification based on the additional resources.

KEYWORDS:

Frozen sections; Molecular markers; Spectroscopy; Surgical margins; Techniques

PMID:
30172560
DOI:
10.1016/j.anl.2018.08.011

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