How Often is Cancer Present in Oral Cavity Re-resections After Initial Positive Margins?

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Surgery

Background:

• Positive surgical margins in head and neck cancer necessitate re-resection to ensure complete tumor removal.
• Understanding the incidence of residual malignancy in re-resection specimens is crucial for optimizing surgical strategies and patient outcomes.

Purpose of the Study:

• To determine the rate of carcinoma in re-resection specimens following initial positive margins in head and neck cancer surgery.
• To evaluate the impact of re-resection and final margin status on oncologic outcomes, specifically overall survival.

Main Methods:

• Retrospective chart review of patients undergoing curative-intent surgery for oral cavity cancer.
• Analysis of final pathology reports to identify patients with initial positive margins requiring same-operation re-resection.
• Application of Cox proportional hazards and Kaplan-Meier analyses to assess survival associations.

Main Results:

• 10.1% of patients (190/1873) had initial positive margins requiring re-resection.
• Additional malignancy (carcinoma, CIS, or severe dysplasia) was found in 29% of re-resection specimens.
• 31% of patients with initial positive margins had final positive margins, with half located at different sites than the initial positive margin.

Conclusions:

• A minority of oral cavity re-resections contain further malignancy, suggesting challenges in precisely locating initial positive margins.
• Final positive margins, particularly when at new sites, are associated with poorer overall survival.
• Surgeons may face difficulties in accurately re-excising the initial positive margin site during re-resection.