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Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way
Published on: May 10, 2021
Management of oral squamous cell carcinoma treated with inadequate excisional biopsy
J S Bailey1, R H Blanchaert, R A Ord
1Oral and Maxillofacial Oncology and Reconstructive Surgery, University of Maryland Medical System, Baltimore, MD, USA. JnthnBail@aol.com
Purpose:
When an initial "excisional biopsy" has been performed on a primary oral carcinoma, microscopic tumor may remain and the usual landmarks that enable the surgeon to plan his safe margin are destroyed. This article analyzes the impact that such a biopsy may have on treatment and patient outcome.
Patients And Methods:
A retrospective chart review of a consecutive series of 350 oral cancer patients treated by 1 surgeon in an 8-year period identified 33 (9.4%) patients who originally had inadequate excisional biopsies. Exclusion criteria eliminated 7 patients who were lost to follow-up or who had undergone previous treatment with radiation therapy or chemotherapy. Data extracted included age, sex, race, primary intraoral site, estimated tumor (T) stage, method of treatment, histology, follow-up, and outcome.
Results:
Twenty-four of the 26 patients underwent re-excision of their oral cancer. Ten of these patients (38.4%) also underwent selective neck dissection. Fifteen of the 24 patients (62.5%) had residual carcinoma identified in the re-excision specimen, and 3 of the patients who underwent elective neck dissection had micrometastasis identified. The patients were followed for an average of 35.5 months. Two of 24 (8.3%) patients had local recurrence at 36 and 84 months, respectively. Both patients were managed with re-excision and are still alive with no evidence of disease. Of the 10 patients originally treated with elective neck dissection, there has been no regional recurrence. However, of the 14 patients who underwent re-excision of the lesion without neck dissection, 3 developed regional disease at 1, 5, and 6 months, respectively, postoperatively. These patients underwent neck dissection and radiation therapy. Two patients are alive with no evidence of disease, and the third died of a second primary lung cancer. Twenty-five of the 26 patients (96.2%) are still alive and well with no evidence of disease.
Conclusions:
Patients who have had inadequate excisional biopsies can be effectively managed with re-excision plus neck dissection when indicated by T stage or more than 3 mm depth of invasion.
