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Updated: Jul 15, 2025
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Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way
Published on: May 10, 2021
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Margin Assessment Methods in Oral Cavity Squamous Cell Carcinoma and Recurrence: Tumor Bed vs Resection Specimen
Shannon S Wu1,2, Neil Woody3, Jennifer Hesse4
1Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California.
JAMA Otolaryngology-- Head & Neck Surgery
|September 28, 2023
Summary
This study found no significant difference in oral cavity squamous cell carcinoma recurrence rates between intraoperative tumor bed and resection specimen margin assessment methods. Both approaches appear equally prognostic for disease recurrence after surgery.
Area of Science:
- Oncology
- Surgical Pathology
- Head and Neck Surgery
Background:
- Positive surgical margins are critical risk factors for recurrence in oral cavity squamous cell carcinoma (OCSCC).
- Current practices for intraoperative margin assessment (tumor bed vs. resection specimen sampling) lack defined prognostic implications.
- Accurate margin assessment guides adjuvant radiation therapy decisions in OCSCC management.
Purpose of the Study:
- To compare the prognostic value of intraoperative margin assessment methods (tumor bed vs. resection specimen sampling) on disease recurrence in OCSCC patients.
- To evaluate the association between different margin sampling techniques and recurrence-free survival following surgical resection for OCSCC.
Main Methods:
- Retrospective cohort study of 223 OCSCC patients undergoing surgical resection between 2000 and 2021.
- Patients were categorized based on intraoperative margin assessment: tumor bed (defect) sampling or resection specimen sampling.
- Disease recurrence was estimated using cumulative incidence and compared between groups using hazard ratios (HRs).
Main Results:
- No significant difference in 3-year rates of local, regional, or distant recurrence was observed between defect-driven and specimen-driven margin sampling cohorts.
- The overall 3-year rate of any recurrence was similar: 18.9% for defect-driven vs. 15.2% for specimen-driven sampling (HR, 0.93).
- While not statistically significant, specimen-driven sampling showed a trend towards lower intraoperative positive margin rates in localized OCSCC.
Conclusions:
- Intraoperative margin assessment methods (tumor bed vs. resection specimen sampling) did not show a clear association with OCSCC recurrence risk.
- Specimen-driven sampling may be associated with lower surgical margin positivity rates, potentially impacting the need for adjuvant therapies.
- Further research is needed to fully elucidate the role of different margin assessment techniques in OCSCC management and adjuvant treatment planning.
