Surgical Margins in Head and Neck Cancer: Intra- and Postoperative Considerations

Robbins KT, Triantafyllou A, Suárez C, López F, Hunt JL, Strojan P, Williams MD, Braakhuis BJM, De Bree R, Hinni ML, Kowalski LP, Rinaldo A, Rodrigo JP, Poorten VV, Nixon IJ, Takes RP, Silver CE and Ferlito A

Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, USA
Department of Dentistry, University of Liverpool, UK
Department of Dentistry, Institute of Health Research of the Principality of Asturias, Spain
Department of oncology, University of Oviedo, Spain
Department of Otolaryngology, University of Oviedo, Spain
Department of Pathology, University of Arkansas for Medical Sciences, USA
Department of Radiation Oncology, Institute of Oncology, Slovenia
Department of Pathology, The University of Texas MD Anderson Cancer Center, USA
Department of Otolaryngology- Head and Neck Surgery, VU University Medical Center, Netherlands
Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Netherlands
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, USA
Department Otolaryngology -Head and Neck Surgery, Centro de Tratamento e Pesquisa Hospital do Cancer A.C. Camargo, Brazil
Department Otolaryngology -Head and Neck Surgery, University of Udine School of Medicine, Udine, Italy
Department of Otolaryngology -Head and Neck Surgery and Oncology, University Hospitals Leuven, Belgium
Departments of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, UK
Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Netherlands
Department of Surgery, University of Arizona College of Medicine, USA
International Head and Neck Scientific Group, Italy

^*Correspondance to: Robbins KT 

 PDF  Full Text Review Article | Open Access

Abstract:

Objective: To provide a perspective on the significance as applied to current practice, we analyzed recent reports on optimizing cancer free surgical margins that have challenged standard practices and novel techniques to assess for occult cancer cells.
Method: We conducted a review of the recent literature (2012-2018) using the keywords surgical margin analysis, frozen and paraffin section techniques, oral cancer, and head and neck cancer.Results: Of significance are the reports indicating superiority of tumor specimen directed sampling of margins compared to patient directed (tumor bed) sampling for frozen section control of oral cancers. With reference to optimal distance between tumor and the surgical margin, recent reports recommended cutoffs less than 5 mm. Employment of new technologies such as light spectroscopy and molecular analysis of tissues, provide opportunities for a “real time” assessment of surgical margins.Conclusion: The commonly practiced method of patient directed margin sampling involving previous studies raises concern over conclusions made regarding the efficacy of frozen section margin control. The recent studies that challenge the optimal distance for clear surgical margins are retrospective and address patient cohorts with inherently confounding factors. The use of novel ancillary techniques requires further refinements, clinical trial validation, and justification based on the additional resources.

Keywords:

Surgical margins; Techniques; Frozen sections; Spectroscopy; Molecular markers

Cite the Article:

Durdu M, Koçer NE. Persistent Napkin Dermatitis: Langerhans Cell Histiocytosis. Clin Oncol. 2018; 3: 1493.