Surgical Outcomes and Margin Assessment by Resection Tool in Tongue Cancer: A Systematic Review

This systematic review aimed to evaluate surgical margin status and related outcomes according to the tool used for tongue resection. A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted up to June 2025. Studies were included if they reported surgical outcomes in tongue cancer resections performed with a specified tool. Key outcomes included margin status, recurrence, thermal damage, functional recovery, and complications. Given insufficient subgroup-level data for meta-analysis, a qualitative synthesis was performed. Fifteen studies were included, comprising 582 patients across six primary resection tools. CO₂ laser and transoral laser microsurgery (TLM) achieved consistently high rates of histologically negative margins but were associated with thermal artefacts that could impair epithelial interpretation, especially in irradiated fields. Harmonic scalpel and ultrasonic dissectors produced clear margins with minimal lateral tissue damage, though long-term oncologic outcomes were underreported. Cold steel provided artefact-free margins but was limited by greater intraoperative bleeding. Electrocautery yielded narrower margins and occasional interpretive artefacts but demonstrated short-term safety in selected patients. Functional outcomes, most robustly reported in TLM cohorts, indicated preserved speech and swallowing with low rates of long-term feeding tube or tracheostomy dependence. Complication rates were low across all modalities. Both thermal and non-thermal resection tools can achieve acceptable oncologic outcomes in tongue cancer surgery. However, margin clarity and interpretability vary substantially by modality. CO₂ laser and ultrasonic/harmonic devices offer favorable profiles, but tool-specific differences in artefact and recurrence warrant further investigation in prospective comparative studies.