The tissue shrinkage phenomenon on surgical margins in oral and oropharyngeal squamous cell carcinoma

Abstract

Aim: One of the most important factors associated with recurrence rate and overall survival is the status of surgical margin of resection free of disease. However, sometimes, the margins measured intra-operatively at the time of surgery differ of those measured by the pathologist in the histopathologic analysis. Faced with this dilemma, a literature review of the best available evidence was conducted in an attempt to determine how the phenomenon of tissue shrinkage may influence on the surgical margin of resection in patients undergoing oral and oropharyngeal squamous cell carcinoma (SCC).

Methods: An electronic and manual search was conducted by one reviewer. A combination of controlled Medical Subjects Headings and keywords were used as search strategy. Inclusion and exclusion criteria were established.

Results: Finally, after an exhaustive selection process, four articles fulfilled the inclusion criteria and were analyzed. All articles reported a decrease of surgical margin after resection. The tumor site and tumor stage seem to influence in degree of margin shrinkage.

Conclusion: Tissue shrinkage on surgical margins of resection in oral SCC is a tangible phenomenon. There is a significant discrepancy between margins measured intraoperatively previous to resection and margins measured by pathologist after histologic processing. The highest percentage of retraction occurs at the time of resection. Margin shrinkage based on tumor site and tumor stage should be considered by any oncologic surgeon to ensure adequate margins of resection cleared of tumor.

Keywords

Squamous cell carcinoma / tissue shrinkage / surgical margin / retraction / oral cavity / oropharynx

References

[1] Stewart BW.World Cancer Report 2014.2014;World Health OrganizationGeneva

[2] Warnakulasuriya S.Global epidemiology of oral and oropharyngeal cancer..Oral Oncol2009;45:309-16

[3] Massano J,Januário G.Oral squamous cell carcinoma: review of prognostic and predictive factors..Oral Surg Oral Med Oral Pathol Oral Radiol Endod2006;102:67-76

[4] Spiro RH,Paulino AF.Pattern of invasion and margin assessment in patients with oral tongue cancer..Head Neck1999;21:408-13

[5] Looser K,Strong E.The significance of "positive" margins in surgically resected epidermoid carcinomas..Head Neck Surg1978;1:107-11

[6] Yahalom R,Vered M,Teicher S.A prospective study of surgical margin status in oral squamous cell carcinoma: a preliminary report..J Surg Oncol2008;98:572-8

[7] Kurita H,Nishizawa R,Kamata T,Kobayashi H.Impact of different surgical margin conditions on local recurrence of oral squamous cell carcinoma..Oral Oncol2010;46:814-7

[8] Hinni ML,Brandwein-Gensler MS,Silver CE,Seethala RR,Corry J,Hunt JL,Devaney KO,Hartl DM,Rinaldo A.Surgical margins in head and neck cancer: a contemporary review..Head Neck2013;35:1362-70

[9] Johnson RE,Funk GF,Hoffman HT.Quantification of surgical margin shrinkage in the oral cavity..Head Neck1997;19:281-6

[10] McMahon J,Pathak I,McNeil E,Gardiner S.Influence of condition of surgical margins on local recurrence and disease-specific survival in oral and oropharyngeal cancer..Br J Oral Maxillofac Surg2003;41:224-31

[11] Nason RW,Pathak KA,Sándor GKB.What is the adequate margin of surgical resection in oral cancer?.Oral Surg Oral Med Oral Pathol Oral Radiol Endod2009;107:625-9

[12] Woolgar JA.A histopathologic appraisal of surgical margins in oral and oropharyngeal cancer resection specimens..Oral Oncol2005;41:1034-43

[13] Brandwein-Gensler M,Lewis CM,Rolnitzky L,Genden E,Wang BY.Oral squamous cell carcinoma: histologic risk assessment, but not margin status, is strongly predictive of local disease-free and overall survival..Am J Surg Pathol2005;29:167-78

[14] Tirelli G,Biasotto M.Open questions and novel concepts in oral cancer surgery..Eur Arch Otorhinolaryngol2015; Epub ahead of print:

[15] Chiou WY,Hsu FC,Ho HC,Lee CC,Wang YC.Buccal mucosa carcinoma: surgical margin less than 3 mm, not 5 mm, predicts locoregional recurrence..Radiat Oncol2010;5:79 PMCID:PMC2946296

[16] Mistry RC,Kumaran C.Post-resection mucosal margin shrinkage in oral cancer: quantification and significance..J Surg Oncol2005;91:131-3

[17] Loree TR.Significance of positive margins in oral cavity squamous carcinoma..Am J Surg1990;160:410-4

[18] Weinstock YE,Dierks EJ.Pitfalls in determining head and neck surgical margins..Oral Maxillofac Surg Clin North Am2014;26:151-62

[19] Anderson CR,Moncrieff M.A meta-analysis of margin size and local recurrence in oral squamous cell carcinoma..Oral Oncol2015;51:464-9

[20] Cheng A,Schmidt BL.Oral squamous cell carcinoma margin discrepancy after resection and pathologic processing..J Oral Maxillofac Surg2008;66:523-9

[21] Upile T,Jerjes W,Searle A,Michaels L,Hopper C,Wright A.The uncertainty of the surgical margin in the treatment of head and neck cancer..Oral Oncol2007;43:321-6

[22] Schardt C,Owens T,Fontelo P.Utilization of the PICO framework to improve searching PubMed for clinical questions..BMC Med Inform Decis Mak2007;7:16 PMCID:PMC1904193

[23] El-Fol HA,Beheiri MG,Kamel MM.Significance of post-resection tissue shrinkage on surgical margins of oral squamous cell carcinoma..J Craniomaxillofacial Surg2015;43:475-82

[24] Egemen O,Orman Ç,Özkaya Ö.Quantification of the surgical margin shrinkage in lip cancer: determining the relation between the surgical and histopathologic margins..J Craniofac Surg2014;25:2152-5

[25] Ravasz LA,Hordijk GJ,van der Tweel I.The status of the resection margin as a prognostic factor in the treatment of head and neck carcinoma..J Craniomaxillofac Surg1991;19:314-8

[26] van Houten VM,Kummer JA,Kuik DJ,Snow GB.Molecular diagnosis of surgical margins and local recurrence in head and neck cancer patients: a prospective study..Clin Cancer Res2004;10:3614-20

[27] Silverman MK,Kopf AW,Vossaert KA,Levenstein MJ.Verification of a formula for determination of preexcision surgical margins from fixed-tissue melanoma specimens..J Am Acad Dermatol1992;27:214-9

[28] Weese JL,Ottery FD.How long is the five centimeter margin?.Surg Gynecol Obstet1986;163:101-3

[29] Siu KF,Wong J.Shrinkage of the esophagus after resection for carcinoma..Ann Surg1986;203:173-6 PMCID:PMC1251066

[30] Sarode SC.A novel "microscopic method" of shrinkage calculation in the pursuance of shrinkage based histopathologic guidelines for interpretation of surgical margins..Oral Oncol2012;48:15-6