Surgical margins of the oral cavity: is 5 mm really necessary?
Abstract Background Squamous cell carcinoma is the most common malignancy of the oral cavity. Primary treatment involves surgical resection of the tumour with a surrounding margin. Historically, the most commonly accepted margin clearance is 5 mm. This distance is controversial, with recent publicat...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40463-022-00584-8 |
| _version_ | 1797964074844160000 |
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| author | James Fowler Yael Campanile Andrew Warner Francisco Laxague Naif Fnais Kevin Fung Adrian Mendez Danielle MacNeil John Yoo David Palma Anthony Nichols |
| author_facet | James Fowler Yael Campanile Andrew Warner Francisco Laxague Naif Fnais Kevin Fung Adrian Mendez Danielle MacNeil John Yoo David Palma Anthony Nichols |
| author_sort | James Fowler |
| collection | DOAJ |
| description | Abstract Background Squamous cell carcinoma is the most common malignancy of the oral cavity. Primary treatment involves surgical resection of the tumour with a surrounding margin. Historically, the most commonly accepted margin clearance is 5 mm. This distance is controversial, with recent publications suggesting closer margins do not impact local recurrence and survival. The objective of this study is to determine the closest surgical margin that does not impact local recurrence and overall survival. Methods A retrospective review of the London Health Sciences Centre Head and Neck Multidisciplinary Clinic between 2010 and 2018 was performed. Demographic data, subsite, tumour staging, treatment modality, margins, and survival outcomes were analyzed. The primary endpoint was local recurrence free survival. Secondary endpoints included recurrence-free survival and overall survival. Descriptive statistics, as well as univariable and multivariable Cox proportional hazards regression modelling were performed for all patients. Results Four-hundred and twelve patients were included in the study, with a median follow-up of 3.3 years. On univariable analysis, positive margins and margins < 1 mm were associated with significantly worse local recurrence-free survival, recurrence-free survival, and overall survival (p < 0.05), compared to margins > 5 mm. Patients with surgical margins > 1 mm experienced similar outcomes to those with margins > 5 mm. Multivariable analysis identified age of diagnosis, alcohol consumption, pathological tumour and nodal category as predictors of local recurrence free survival. Conclusions Although historical margins for head and neck surgery are 5 mm, similar outcomes were observed for margins greater than 1 mm in our cohort. These findings require validation through multi-institutional collaborative efforts. Graphical abstract |
| first_indexed | 2024-04-11T01:38:17Z |
| format | Article |
| id | doaj.art-b74eced8496d4fefbcff1c79a82152ce |
| institution | Directory Open Access Journal |
| issn | 1916-0216 |
| language | English |
| last_indexed | 2024-04-11T01:38:17Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj.art-b74eced8496d4fefbcff1c79a82152ce2023-01-03T08:48:51ZengBMCJournal of Otolaryngology - Head and Neck Surgery1916-02162022-10-015111710.1186/s40463-022-00584-8Surgical margins of the oral cavity: is 5 mm really necessary?James Fowler0Yael Campanile1Andrew Warner2Francisco Laxague3Naif Fnais4Kevin Fung5Adrian Mendez6Danielle MacNeil7John Yoo8David Palma9Anthony Nichols10Department of Otolaryngology – Head and Neck Surgery, Victoria Hospital, London Health Science Centre, Western UniversityWestern UniversityDepartment of Radiation Oncology, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Victoria Hospital, London Health Science Centre, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Victoria Hospital, London Health Science Centre, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Victoria Hospital, London Health Science Centre, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Victoria Hospital, London Health Science Centre, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Victoria Hospital, London Health Science Centre, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Victoria Hospital, London Health Science Centre, Western UniversityDepartment of Radiation Oncology, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Victoria Hospital, London Health Science Centre, Western UniversityAbstract Background Squamous cell carcinoma is the most common malignancy of the oral cavity. Primary treatment involves surgical resection of the tumour with a surrounding margin. Historically, the most commonly accepted margin clearance is 5 mm. This distance is controversial, with recent publications suggesting closer margins do not impact local recurrence and survival. The objective of this study is to determine the closest surgical margin that does not impact local recurrence and overall survival. Methods A retrospective review of the London Health Sciences Centre Head and Neck Multidisciplinary Clinic between 2010 and 2018 was performed. Demographic data, subsite, tumour staging, treatment modality, margins, and survival outcomes were analyzed. The primary endpoint was local recurrence free survival. Secondary endpoints included recurrence-free survival and overall survival. Descriptive statistics, as well as univariable and multivariable Cox proportional hazards regression modelling were performed for all patients. Results Four-hundred and twelve patients were included in the study, with a median follow-up of 3.3 years. On univariable analysis, positive margins and margins < 1 mm were associated with significantly worse local recurrence-free survival, recurrence-free survival, and overall survival (p < 0.05), compared to margins > 5 mm. Patients with surgical margins > 1 mm experienced similar outcomes to those with margins > 5 mm. Multivariable analysis identified age of diagnosis, alcohol consumption, pathological tumour and nodal category as predictors of local recurrence free survival. Conclusions Although historical margins for head and neck surgery are 5 mm, similar outcomes were observed for margins greater than 1 mm in our cohort. These findings require validation through multi-institutional collaborative efforts. Graphical abstracthttps://doi.org/10.1186/s40463-022-00584-8MarginSquamous cellCarcinomaOral cavity |
| spellingShingle | James Fowler Yael Campanile Andrew Warner Francisco Laxague Naif Fnais Kevin Fung Adrian Mendez Danielle MacNeil John Yoo David Palma Anthony Nichols Surgical margins of the oral cavity: is 5 mm really necessary? Journal of Otolaryngology - Head and Neck Surgery Margin Squamous cell Carcinoma Oral cavity |
| title | Surgical margins of the oral cavity: is 5 mm really necessary? |
| title_full | Surgical margins of the oral cavity: is 5 mm really necessary? |
| title_fullStr | Surgical margins of the oral cavity: is 5 mm really necessary? |
| title_full_unstemmed | Surgical margins of the oral cavity: is 5 mm really necessary? |
| title_short | Surgical margins of the oral cavity: is 5 mm really necessary? |
| title_sort | surgical margins of the oral cavity is 5 mm really necessary |
| topic | Margin Squamous cell Carcinoma Oral cavity |
| url | https://doi.org/10.1186/s40463-022-00584-8 |
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