Optimizing surgical margins in oral cancer without frozen section: A single center retrospective study

Frozen section analysis has been a cornerstone in intraoperative pathological evaluation for oral cancer surgeries, aiding in achieving tumor-free margins. However, its utility and availability are subjects of ongoing debate and research. This study evaluates the efficacy of a guideline-based approach to surgical resection margins in the absence of frozen section analysis in a resource-constrained setting.

We conducted a retrospective audit of 490 oral cavity cancer patients treated from December 2021 to December 2023 at our center, where frozen section analysis was not available. Surgical resections adhered to the guidelines of maintaining 1 cm mucosal soft tissue and base margins, and a 7 mm specimen-driven margin assessment intraoperatively. The outcomes measured were the rates of close (between 1 mm and 5 mm) and involved (less than or equal to 1 mm) margins in final histopathology reports (HPR).

448 patients were included in our audit. On final HPR, a gross margin of 7 mm or more achieved intraoperatively translated into safe (more than 5 mm) margins in 410 patients (91.1 %). 25 (5.1 %) had at least one close margin, of which 11 were technical due to the desire to minimize functional morbidity. 15 (3.1 %) had involved margins, where R0 resection was not achieved due to anatomical constraints. An additional finding was the correlation of compromised margins with worst pattern of invasion (WPOI) 4&5 on Chi-square analysis (p = 0.021) and depth of invasion (DOI) more than 5 mm (OR 3.81, p = 0.010).

This study indicates that a margin of 7 mm or more intraoperatively translates into safe margins on final HPR, and calls for a pragmatic and judicious use of FS in the interest of choosing wisely.