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Double-bladed scalpel: a new option for harvesting margins in head and neck cancers
Claudio R Cernea1, Otavio Velasco, Marcos Q T Gomes
1Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil. cerneamd@uol.com.br
Background:
In advanced head and neck tumors margins are very rarely comprehensively checked by frozen sections. The goal of this study was to analyze a new proposal for harvesting margins using a double-bladed scalpel.
Methods:
Thirty-eight patients underwent a comprehensive resection of advanced head and neck tumors with a double-bladed scalpel. Margins were mapped and checked by frozen sections, while tumor resection continued. When positive margins were identified, they were excised again, and checked by frozen sections.
Results:
Thirty-three patients (87%) had clear skin and soft tissue margins at frozen sections. Five patients (13%) had focal skin and soft tissue-positive margins at frozen sections, which were re-excised. Two patients (5%) had skin and soft tissue-positive margins only at permanent sections. One was reoperated and 1 received radiation therapy. The 3-year local control rate was 58%.
Conclusions:
In this preliminary study, the double-bladed scalpel appeared to be an interesting option for complete intraoperative evaluation of surgical margins of advanced head and neck tumors.
Insights
A novel double-bladed scalpel technique allows for comprehensive intraoperative evaluation of surgical margins in advanced head and neck tumors, improving margin assessment during resection.
Area of Science:
- Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Comprehensive margin assessment is crucial for advanced head and neck tumors but rarely achieved with frozen sections.
- Current methods often fail to provide complete intraoperative margin evaluation.
Purpose of the Study:
- To evaluate a new technique using a double-bladed scalpel for comprehensive intraoperative margin assessment in advanced head and neck tumors.
Main Methods:
- Thirty-eight patients with advanced head and neck tumors underwent resection using a double-bladed scalpel.
- Margins were mapped and assessed via frozen sections during tumor resection.
- Positive margins identified during frozen section analysis were re-excised and re-evaluated.
Main Results:
- 87% of patients achieved clear skin and soft tissue margins on initial frozen section analysis.
- 13% of patients had focal positive margins requiring re-excision.
- 5% of patients had positive margins on permanent sections, necessitating further treatment.
Conclusions:
- The double-bladed scalpel shows promise for complete intraoperative evaluation of surgical margins in advanced head and neck cancer.
- This technique may enhance surgical decision-making and improve local control rates.