Significance of post-resection tissue shrinkage on surgical margins of oral squamous cell carcinoma.
BACKGROUND
Resecting oral squamous cell carcinoma (SCC) with an appropriate margin of uninvolved tissue is critical in preventing local recurrence and in making decisions regarding postoperative radiation therapy. This task can be difficult due to the discrepancy between margins measured intraoperatively and those measured microscopically by the pathologist after specimen processing.


METHODS
A total of 61 patients underwent resective surgery with curative intent for primary oral SCC were included in this study. All patients underwent resection of the tumor with a measured 1-cm margin. Specimens were then submitted for processing and reviewing, and histopathologic margins were measured. The closest histopathologic margin was compared with the in situ margin (1 cm) to determine the percentage discrepancy.


RESULTS
The mean discrepancy between the in situ margins and the histopathological margins of all close and positive margins were 47.6% for the buccal mucosa (with a P value corresponding to 0.05 equaling 2.1), which is statistically significant, 4.8% for the floor of mouth, 9.5% for the mandibular alveolus, 4.8% for the retromolar trigon, and 33.3% for the tongue.


CONCLUSIONS
There is a significant difference among resection margins based on tumor anatomical location. Margins shrinkage after resection and processing should be considered at the time of the initial resection. Tumors located in the buccal mucosa show significantly greater discrepancies than tumors at other sites. These findings suggest that it is critical to consider the oral site when outlining margins to ensure adequacy of resection. Buccal SCC is an aggressive disease, and should be considered as an aggressive subsite within the oral cavity, requiring a radical and aggressive resective approach.
Department of Surgical Oncology, Faculty of Medicine, Menofia University, Egypt.
Hossam Abdelkader
HA
El-Fol
Department of Oral & Maxillofacial Surgery, Faculty of Oral & Dental Medicine, Sana'a University, Yemen. Electronic address: samer_noman@yahoo.com.
Samer Abduljabar
SA
Noman
Department of Oral & Maxillofacial Surgery, Faculty of Oral & Dental Medicine, Cairo University, Egypt.
Mohamed Galal
MG
Beheiri
Department of Pathology, Faculty of Medicine, Cairo University, Egypt.
Abdalla M
AM
Khalil
Department of Clinical Pathology, National Cancer Institute, Cairo University, Egypt.
Mahmoud Mohamed
MM
Kamel
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002610:Cheek / Q000473:pathology / Q000601:surgery; D005260:Female; D005881:Gingiva / Q000473:pathology / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009060:Mouth Floor / Q000473:pathology / Q000601:surgery; D009061:Mouth Mucosa / Q000473:pathology / Q000601:surgery*; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D037981:Neck Dissection / Q000379:methods; D009367:Neoplasm Staging; D011446:Prospective Studies; D013048:Specimen Handling; D014062:Tongue Neoplasms / Q000473:pathology / Q000601:surgery
Margins shrinkage; Oral squamous cell carcinoma; Resection margins