Upile T, Fisher C, Jerjes W, El Maaytah M, Searle A, Archer D, Michaels L, Rhys-Evans P, Hopper C, Howard D, Wright A
Department of Head & Neck Surgery, The Royal Marsden Hospital, London, UK.
Oral Oncol. 2007 Apr;43(4):321-6. doi: 10.1016/j.oraloncology.2006.08.002. Epub 2006 Nov 16.
We discuss our surgical philosophy concerning the subtle interplay between the size of the surgical margin taken and the resultant morbidity from ablative oncological procedures, which is ever more evident in the treatment of head and neck malignancy. The extent of tissue resection is determined by the "trade off" between cancer control and the perioperative, functional and aesthetic morbidity and mortality of the surgery. We also discuss our dilemmas concerning recent minimally invasive endoscopic microsurgical techniques for the trans-oral laser removal or co-ablation of aero-digestive tract tumours, which result in a minimal surgical margin of oncological clearance. By a process of inductive argument as to the nature of the surgical margin, we consider whether the risks of taking a lesser margin with adjuvant therapy is justified by the attendant gain in reduced surgical morbidity and the possible costs in tumour control.
我们讨论了关于手术切缘大小与消融性肿瘤手术所致并发症之间微妙相互作用的手术理念，这在头颈部恶性肿瘤的治疗中愈发明显。组织切除范围取决于癌症控制与手术围手术期、功能及美学方面的并发症和死亡率之间的“权衡”。我们还讨论了近期用于经口激光切除或联合消融气道消化道肿瘤的微创内镜显微手术技术所带来的困境，这些技术导致肿瘤学切缘的手术切缘极小。通过对手术切缘性质的归纳论证过程，我们思考了采用较小切缘并辅以辅助治疗的风险，是否因手术并发症减少带来的相应益处以及肿瘤控制方面可能的代价而合理。
