Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer.
OBJECTIVES
Piecemeal resection provides an innovative conceptual tool for margins surveillance because it entails the intraoperative evaluation of the whole resection margins and not just sample points, which should result in a better control of deep margins compared to en bloc resection. Although it is recognized that the intraoperative use of narrow band imaging (NBI) results in a better control of superficial margins, in this exploratory study we investigated whether NBI and piecemeal resection could be used in combination to improve margin control at both superficial and deep levels. Because piecemeal resection is based on frozen section analysis, we wanted to verify its reliability compared to definitive histological examination.


METHODS
The status of resection margins in a group of patients with oral and oropharyngeal cancers treated with NBI and laser CO2 piecemeal resection (group 1) was compared with that of an historical group of patients (group 2) treated with NBI and conventional en bloc resection. In group 1, sensitivity, specificity, and positive and negative predictive values were used to verify the rate of concordance between frozen section and definitive histology.


RESULTS
The difference between deep positive margins in the two groups was statistically significant (P = 0.042). The high sensitivity and specificity (94.6% and 94.7%, respectively) of frozen section analysis also demonstrated its reliability in the examination of larger samples corresponding to the whole margin.


CONCLUSION
Even if our findings are limited by the small number of patients, we are confident that the combined use of NBI and piecemeal resection could represent an attractive surgical strategy to improve margin control.


LEVEL OF EVIDENCE
2b Laryngoscope, 129:1810-1815, 2019.
['Tirelli|Giancarlo|G|', 'Boscolo Nata|Francesca|F|', 'Gatto|Annalisa|A|', 'Bussani|Rossana|R|', 'Spinato|Giacomo|G|', 'Zacchigna|Serena|S|', 'Piovesana|Marco|M|']
D000368:Aged D000369:Aged, 80 and over D005260:Female D005629:Frozen Sections D006801:Humans D007430:Intraoperative Care D008297:Male D000072662:Margins of Excision D008875:Middle Aged D009062:Mouth Neoplasms D062048:Narrow Band Imaging D009367:Neoplasm Staging D009959:Oropharyngeal Neoplasms D015203:Reproducibility of Results D012680:Sensitivity and Specificity
intraoperative margin control transoral approach Piecemeal resection narrow band imaging frozen section analysis