Surgical margins in head and neck cancer: Intra- and postoperative considerations

K Thomas Robbins; Asterios Triantafyllou; Carlos Suárez; Fernando López; Jennifer L Hunt; Primož Strojan; Michelle D Williams; Boudewijn J M Braakhuis; Remco de Bree; Michael L Hinni; Luiz P Kowalski; Alessandra Rinaldo; Juan P Rodrigo; Vincent Vander Poorten; Iain J Nixon; Robert P Takes; Carl E Silver; Alfio Ferlito

doi:10.1016/j.anl.2018.08.011

Surgical margins in head and neck cancer: Intra- and postoperative considerations

K Thomas Robbins, Asterios Triantafyllou, Carlos Suárez, Fernando López, Jennifer L Hunt, Primož Strojan, Michelle D Williams, Boudewijn J M Braakhuis, Remco de Bree, Michael L Hinni, Luiz P Kowalski, Alessandra Rinaldo, Juan P Rodrigo, Vincent Vander Poorten, Iain J Nixon, Robert P Takes, Carl E Silver, Alfio Ferlito

Research output: Contribution to journal › Review article › peer-review

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 5mm. 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.

Original language	English
Pages (from-to)	10-17
Number of pages	8
Journal	Auris, Nasus, Larynx
Volume	46
Issue number	1
Early online date	29 Aug 2018
DOIs	https://doi.org/10.1016/j.anl.2018.08.011
Publication status	Published - Feb 2019

Keywords

Review
Molecular markers
Spectroscopy
Techniques
Surgical margins
Frozen sections
Frozen Sections
Tomography, Optical Coherence
Humans
Margins of Excision
Spectrometry, Fluorescence
Squamous Cell Carcinoma of Head and Neck/diagnostic imaging
Paraffin Embedding
Mass Spectrometry
Ultrasonography
Spectrum Analysis, Raman
Endoscopy
Spectrum Analysis
Biomarkers, Tumor/metabolism
Head and Neck Neoplasms/diagnostic imaging

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10.1016/j.anl.2018.08.011

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Thomas Robbins, K., Triantafyllou, A., Suárez, C., López, F., Hunt, J. L., Strojan, P., Williams, M. D., Braakhuis, B. J. M., de Bree, R., Hinni, M. L., Kowalski, L. P., Rinaldo, A., Rodrigo, J. P., Vander Poorten, V., Nixon, I. J., Takes, R. P., Silver, C. E., & Ferlito, A. (2019). Surgical margins in head and neck cancer: Intra- and postoperative considerations. Auris, Nasus, Larynx, 46(1), 10-17. https://doi.org/10.1016/j.anl.2018.08.011

@article{5bf09f63d4bb4501b5f2b2582e0fc336,

title = "Surgical margins in head and neck cancer: Intra- and postoperative considerations",

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 5mm. 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 = "Review, Molecular markers, Spectroscopy, Techniques, Surgical margins, Frozen sections, Frozen Sections, Tomography, Optical Coherence, Humans, Margins of Excision, Spectrometry, Fluorescence, Squamous Cell Carcinoma of Head and Neck/diagnostic imaging, Paraffin Embedding, Mass Spectrometry, Ultrasonography, Spectrum Analysis, Raman, Endoscopy, Spectrum Analysis, Biomarkers, Tumor/metabolism, Head and Neck Neoplasms/diagnostic imaging",

author = "{Thomas Robbins}, K and Asterios Triantafyllou and Carlos Su{\'a}rez and Fernando L{\'o}pez and Hunt, {Jennifer L} and Primo{\v z} Strojan and Williams, {Michelle D} and Braakhuis, {Boudewijn J M} and {de Bree}, Remco and Hinni, {Michael L} and Kowalski, {Luiz P} and Alessandra Rinaldo and Rodrigo, {Juan P} and {Vander Poorten}, Vincent and Nixon, {Iain J} and Takes, {Robert P} and Silver, {Carl E} and Alfio Ferlito",

year = "2019",

month = feb,

doi = "10.1016/j.anl.2018.08.011",

language = "English",

volume = "46",

pages = "10--17",

journal = "Auris, Nasus, Larynx",

issn = "0385-8146",

publisher = "Elsevier Ireland Ltd",

number = "1",

}

Thomas Robbins, K, Triantafyllou, A, Suárez, C, López, F, Hunt, JL, Strojan, P, Williams, MD, Braakhuis, BJM, de Bree, R, Hinni, ML, Kowalski, LP, Rinaldo, A, Rodrigo, JP, Vander Poorten, V, Nixon, IJ, Takes, RP, Silver, CE & Ferlito, A 2019, 'Surgical margins in head and neck cancer: Intra- and postoperative considerations', Auris, Nasus, Larynx, vol. 46, no. 1, pp. 10-17. https://doi.org/10.1016/j.anl.2018.08.011

TY - JOUR

T1 - Surgical margins in head and neck cancer

T2 - Intra- and postoperative considerations

AU - Thomas Robbins, K

AU - Triantafyllou, Asterios

AU - Suárez, Carlos

AU - López, Fernando

AU - Hunt, Jennifer L

AU - Strojan, Primož

AU - Williams, Michelle D

AU - Braakhuis, Boudewijn J M

AU - de Bree, Remco

AU - Hinni, Michael L

AU - Kowalski, Luiz P

AU - Rinaldo, Alessandra

AU - Rodrigo, Juan P

AU - Vander Poorten, Vincent

AU - Nixon, Iain J

AU - Takes, Robert P

AU - Silver, Carl E

AU - Ferlito, Alfio

PY - 2019/2

Y1 - 2019/2

N2 - 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 5mm. 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.

AB - 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 5mm. 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.

KW - Review

KW - Molecular markers

KW - Spectroscopy

KW - Techniques

KW - Surgical margins

KW - Frozen sections

KW - Frozen Sections

KW - Tomography, Optical Coherence

KW - Humans

KW - Margins of Excision

KW - Spectrometry, Fluorescence

KW - Squamous Cell Carcinoma of Head and Neck/diagnostic imaging

KW - Paraffin Embedding

KW - Mass Spectrometry

KW - Ultrasonography

KW - Spectrum Analysis, Raman

KW - Endoscopy

KW - Spectrum Analysis

KW - Biomarkers, Tumor/metabolism

KW - Head and Neck Neoplasms/diagnostic imaging

UR - http://www.scopus.com/inward/record.url?scp=85054170793&partnerID=8YFLogxK

U2 - 10.1016/j.anl.2018.08.011

DO - 10.1016/j.anl.2018.08.011

M3 - Review article

C2 - 30172560

SN - 0385-8146

VL - 46

SP - 10

EP - 17

JO - Auris, Nasus, Larynx

JF - Auris, Nasus, Larynx

IS - 1

ER -

Surgical margins in head and neck cancer: Intra- and postoperative considerations

Abstract

Keywords

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