Abstract
Objective
To provide a perspective on the significance of recent reports for optimizing cancer
free surgical margins that have challenged standard practices.
Methods
We conducted a review of the recent literature (2012–2018) using the keywords surgical
margin analysis, frozen and paraffin section techniques, head and neck cancer, spectroscopy
and molecular markers.
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.
Conclusions
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 require further refinements, clinical
trial validation, and justification based on the additional resources.
Keywords
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Article info
Publication history
Published online: August 29, 2018
Accepted:
August 15,
2018
Received:
June 6,
2018
Footnotes
☆This article was written by members of the International Head and Neck Scientific Group (www.IHNSG.com).
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
