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Updated: Jul 22, 2026
Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way
Published on: May 10, 2021
Histopathological Margins and Recurrence Risk in Oral Squamous Cell Carcinoma: Is 3 mm Enough?
C C E van de Schoor1, G K P Bittermann2, E R C Hagens3
1Researcher, Department of Cranio-Maxillofacial Surgery, Maastricht Comprehensive Cancer Center, Maastricht University Medical Center, Maastricht, The Netherlands.
Background:
Among patients with oral squamous cell carcinoma (OSCC), achieving adequate histopathological resection margins is critical to reduce recurrence risk. Although a ≥5 mm margin is the accepted standard, recent discussions suggest that smaller margins, such as ≥3 mm, may offer comparable oncologic outcomes.
Purpose:
The purpose of this study was to evaluate the prognostic significance of histopathological margin width in patients with OSCC and to potentially minimize the risk of overtreatment.
Study Design And Setting:
This retrospective cohort study was conducted at the Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center. Patients ≥18 years who underwent primary surgical resection for OSCC between January 2014 and December 2018 were included. The exclusion criteria were recurrent disease, incomplete pathology reports, or nonconfirmed malignancy.
Predictor Variable:
The predictor variable was histologic resection margin, and subjects were grouped into 3 groups based on histopathological resection margin: group 1: <3 mm, group 2: 3-4.99 mm, and group 3: ≥5 mm.
Main Outcome Variables:
The outcome variable was therapeutic effect measured using recurrence-free survival (RFS) and overall survival (OS).
Covariates:
Collected covariates included age, sex, smoking status, tumor site and stage, perineural invasion, lymphovascular invasion, extranodal extension, growth pattern, presence of adjacent tooth, intraoperative reresection, radiotherapy, and additional surgery.
Analyses:
Univariable and multivariable Cox regression analyses were performed, and Kaplan-Meier curves visualized RFS and OS. A P value <.05 was considered significant.
Results:
The sample was composed of 157 subjects with a mean age of 67 (±11.2) and 75 (47.8%) were male. Margins ≥5 mm were achieved in 70 (44.6%) subjects. No significant difference in RFS was observed between 3 to 4.99 mm and ≥5 mm (hazard ratio = 2.071; CI, 0.736 to 5.828; P = .2). OS did not significantly differ between groups hazard ratio = 1.346, 95% CI 0.667 to 2.717, P = .4).
Conclusions And Relevance:
Margins ≥3 mm may offer comparable oncologic outcomes to ≥5 mm, potentially reducing overtreatment in selected OSCC patients.
