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Updated: May 25, 2026
Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way
Published on: May 10, 2021
Navigation-assisted surgery using an image-guided platform improves margin control and survival in advanced oral
Abstract:
Negative surgical margins are essential for curative resection in oral squamous cell carcinoma (OSCC), yet adequate clearance in very advanced tumors can be limited by complex craniofacial anatomy. This single-center retrospective cohort study screened 826 surgically treated patients at MacKay Memorial Hospital (2014-2024) and identified 109 patients with American Joint Committee on Cancer 8th edn T4b disease who met inclusion criteria, including 52 who underwent navigation-assisted resection using the Brainlab image-guided platform and 57 who underwent conventional surgery. The primary endpoint was pathological margin status (negative, ≥5 mm; close, ≥1 mm to <5 mm; positive, <1 mm or at the inked margin), and secondary endpoints were disease-free survival (DFS) and overall survival (OS). Navigation-assisted surgery achieved a higher negative-margin rate than conventional surgery (55.7% vs 22.8%; P = 0.0016), with fewer close margins (28.8% vs 56.1%) and fewer positive margins (15.3% vs 21.1%). Median DFS was 27.9 months with navigation and 15.4 months with conventional surgery (log-rank P = 0.041), and median OS was 36.37 vs 18.4 months (log-rank P = 0.030); 5-year OS rates were 33.3% and 17.8%, respectively. In multivariable Cox regression adjusting for nodal stage, perineural invasion, and lymphovascular invasion, navigation-assisted surgery was associated with improved DFS (adjusted hazard ratio (aHR) 0.501; 95% confidence interval (CI) 0.315-0.825; P = 0.011) and OS (aHR 0.547; 95% CI 0.337-0.888; P = 0.015). Navigation-assisted surgery was associated with improved margin control and longer survival in surgically treated T4b OSCC, supporting its use as an adjunct for anatomically complex resections.
Insights
Navigation-assisted surgery improves outcomes for advanced oral squamous cell carcinoma (OSCC). This technique enhances negative surgical margins and increases disease-free survival (DFS) and overall survival (OS) in T4b OSCC patients.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Technology
Background:
- Achieving negative surgical margins is crucial for curative resection in oral squamous cell carcinoma (OSCC).
- Complex craniofacial anatomy poses challenges for adequate tumor clearance in advanced OSCC cases.
- T4b stage OSCC presents significant surgical difficulties due to tumor extent.
Purpose of the Study:
- To evaluate the effectiveness of navigation-assisted surgery compared to conventional surgery for T4b OSCC.
- To assess the impact of navigation-assisted surgery on pathological margin status.
- To determine the effect of navigation-assisted surgery on disease-free survival (DFS) and overall survival (OS) in T4b OSCC patients.
Main Methods:
- A retrospective cohort study of 109 patients with T4b OSCC treated between 2014-2024.
- Comparison between 52 patients undergoing navigation-assisted resection (Brainlab platform) and 57 patients undergoing conventional surgery.
- Analysis of pathological margin status (negative, close, positive), DFS, and OS.
Main Results:
- Navigation-assisted surgery achieved a significantly higher negative-margin rate (55.7% vs 22.8%, P = 0.0016).
- Patients in the navigation group had improved median DFS (27.9 vs 15.4 months, P = 0.041) and median OS (36.37 vs 18.4 months, P = 0.030).
- Multivariable analysis confirmed navigation-assisted surgery was associated with improved DFS (aHR 0.501) and OS (aHR 0.547).
Conclusions:
- Navigation-assisted surgery significantly improves margin control in surgically treated T4b OSCC.
- This technique is associated with longer disease-free and overall survival for patients with advanced OSCC.
- Navigation-assisted surgery is a valuable adjunct for complex craniofacial resections in T4b OSCC.
