Adequacy of surgical margins in oral cancer patients with respect to various types of reconstruction

Apurva Garg; Manish Mair; Hitesh Singhavi; Muddasir Bhati; Akshat Malik; Aseem Mishra; Deepa Nair; Sudhir Nair; Pankaj Chaturvedi

doi:10.4103/sajc.sajc_366_18

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ORIGINAL ARTICLE: Head and Neck Cancers

09 (

); 34-37

doi:

10.4103/sajc.sajc_366_18

Adequacy of surgical margins in oral cancer patients with respect to various types of reconstruction

Apurva Garg¹, Manish Mair^1,, Hitesh Singhavi¹, Muddasir Bhati¹, Akshat Malik¹, Aseem Mishra¹, Deepa Nair¹, Sudhir Nair¹, Pankaj Chaturvedi¹

1 Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai, Maharashtra

*Corresponding author: Dr. Manish Mair. manishmair@gmail.com

Published: 2020-12-14

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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Abstract

Bacground: Surgical margin is an important prognostic factor for oral cancers (oral squamous cell carcinoma [OSCC]). The correlation of margin with the type of reconstruction has never been studied. Aim: This study aimed to correlate surgical margins with the type of reconstruction. Methods: This was a retrospective study of 410 treatment-naïve OSCC patients. As per the methods of reconstruction, three groups were made when reconstruction was performed using pedicled flap (PF) or local flap, free flap, and primary closure (PC). Statistical Analysis: Chi-square test was used for comparison of margin status as per the method of reconstruction. Mann–Whitney test was used to find the difference between the mean margin width with respect to the type of reconstruction. Results: The overall incidence of close/positive margins was 7.8%. The incidence of close/positive margins was not significantly different in free flap group compared to PF (P = 0.06) or PC (P = 0.835) group. However, there was a significant difference in the incidence of close/positive margins between PC and PF groups (P = 0.021). Whether the reconstruction is performed by the primary surgeon or by a another surgeon, it did not have an impact on adequacy of margins (P = 0.334). Margins were wider when the reconstruction is performed by a different team (P = 0.015) or when reconstruction is performed as compared to PC. Conclusion: Margins are not affected by the type of reconstruction (pedicled vs. free flap) and the team doing reconstruction (same vs. another team). Margins are significantly compromised when a surgeon performs PC himself/herself compared to PF.

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References

GLOBOCAN; 2012. Available from: http://www.globocan.iarc.fr/old/summary_table_pop-html.asp?selection=224900&title=World&sex=0 &type=0&window=1&sort=0&submit=%C2%A0Execute%C2%A0. [Last accessed on 2017 Oct 15].
Woolgar JA, Scott J, Vaughan ED, Brown JS, West CR, Rogers S, et al. Survival, metastasis and recurrence of oral cancer in relation to pathological features. Ann R Coll Surg Engl 1995;77:325-31.
Sutton DN, Brown JS, Rogers SN, Vaughan ED, Woolgar JA. The prognostic implications of the surgical margin in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2003;32:30-4.
Loree TR, Strong EW. Significance of positive margins in oral cavity squamous carcinoma. Am J Surg 1990;160:410-4.
Chandu A, Adams G, Smith AC. Factors affecting survival in patients with oral cancer: An Australian perspective. Int J Oral Maxillofac Surg 2005;34:514-20.
Spiro RH, Guillamondegui O Jr., Paulino AF, Huvos AG. Pattern of invasion and margin assessment in patients with oral tongue cancer. Head Neck 1999;21:408-13.
Mair M, Nair D, Nair S, Dutta S, Garg A, Malik A, et al. Intraoperative gross examination vs. frozen section for achievement of adequate margin in oral cancer surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2017;123:544-9.
Forner D, Phillips T, Rigby M, Hart R, Taylor M, Trites J, et al. Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: A case series and cost analysis. J Otolaryngol Head Neck Surg 2016;45:11.
Edwards SP. Margin analysis-has free tissue transfer improved oncologic outcomes for oral squamous cell carcinoma? Oral Maxillofac Surg Clin North Am 2017;29:377-81.
McCrory AL, Magnuson JS. Free tissue transfer versus pedicled flap in head and neck reconstruction. Laryngoscope 2002;112:2161-5.
Hsieh TY, Chang KP, Lee SS, Chang CH, Lai CH, Wu YC, et al. Free flap reconstruction in patients with advanced oral squamous cell carcinoma: Analysis of patient survival and cancer recurrence. Microsurgery 2012;32:598-604.
de Vicente JC, Rodríguez-Santamarta T, Rosado P, Peña I, de Villalaín L. Survival after free flap reconstruction in patients with advanced oral squamous cell carcinoma. J Oral Maxillofac Surg 2012;70:453-9.
Hanasono MM, Friel MT, Klem C, Hsu PW, Robb GL, Weber RS, et al. Impact of reconstructive microsurgery in patients with advanced oral cavity cancers. Head Neck 2009;31:1289-96.
Chauhan A, Sharma MM. Evaluation of surgical outcomes following oncoplastic breast surgery in early breast cancer and comparison with conventional breast conservation surgery. Med J Armed Forces India 2016;72:12-8.

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[1] GLOBOCAN; 2012. Available from: http://www.globocan.iarc.fr/old/summary_table_pop-html.asp?selection=224900&title=World&sex=0 &type=0&window=1&sort=0&submit=%C2%A0Execute%C2%A0. [Last accessed on 2017 Oct 15].

[2] Woolgar JA, Scott J, Vaughan ED, Brown JS, West CR, Rogers S, et al. Survival, metastasis and recurrence of oral cancer in relation to pathological features. Ann R Coll Surg Engl 1995;77:325-31.

[3] Sutton DN, Brown JS, Rogers SN, Vaughan ED, Woolgar JA. The prognostic implications of the surgical margin in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2003;32:30-4.

[4] Loree TR, Strong EW. Significance of positive margins in oral cavity squamous carcinoma. Am J Surg 1990;160:410-4.

[5] Chandu A, Adams G, Smith AC. Factors affecting survival in patients with oral cancer: An Australian perspective. Int J Oral Maxillofac Surg 2005;34:514-20.

[6] Spiro RH, Guillamondegui O Jr., Paulino AF, Huvos AG. Pattern of invasion and margin assessment in patients with oral tongue cancer. Head Neck 1999;21:408-13.

[7] Mair M, Nair D, Nair S, Dutta S, Garg A, Malik A, et al. Intraoperative gross examination vs. frozen section for achievement of adequate margin in oral cancer surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2017;123:544-9.

[8] Forner D, Phillips T, Rigby M, Hart R, Taylor M, Trites J, et al. Submental island flap reconstruction reduces cost in oral cancer reconstruction compared to radial forearm free flap reconstruction: A case series and cost analysis. J Otolaryngol Head Neck Surg 2016;45:11.

[9] Edwards SP. Margin analysis-has free tissue transfer improved oncologic outcomes for oral squamous cell carcinoma? Oral Maxillofac Surg Clin North Am 2017;29:377-81.

[10] McCrory AL, Magnuson JS. Free tissue transfer versus pedicled flap in head and neck reconstruction. Laryngoscope 2002;112:2161-5.

[11] Hsieh TY, Chang KP, Lee SS, Chang CH, Lai CH, Wu YC, et al. Free flap reconstruction in patients with advanced oral squamous cell carcinoma: Analysis of patient survival and cancer recurrence. Microsurgery 2012;32:598-604.

[12] de Vicente JC, Rodríguez-Santamarta T, Rosado P, Peña I, de Villalaín L. Survival after free flap reconstruction in patients with advanced oral squamous cell carcinoma. J Oral Maxillofac Surg 2012;70:453-9.

[13] Hanasono MM, Friel MT, Klem C, Hsu PW, Robb GL, Weber RS, et al. Impact of reconstructive microsurgery in patients with advanced oral cavity cancers. Head Neck 2009;31:1289-96.

[14] Chauhan A, Sharma MM. Evaluation of surgical outcomes following oncoplastic breast surgery in early breast cancer and comparison with conventional breast conservation surgery. Med J Armed Forces India 2016;72:12-8.

Adequacy of surgical margins in oral cancer patients with respect to various types of reconstruction

Abstract

Abstract

Keywords

References

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