Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Acta Otolaryngol. 2020 Oct;140(10):869-875. doi: 10.1080/00016489.2020.1773532. Epub 2020 Jun 21.
The width of the surgical resection margin impacts recurrence and survival in oral cavity squamous cell carcinoma (OSCC). The most commonly used definition of a clear margin is one larger than 5 mm, although due to anatomical restrictions to e.g. bone or vessels, this size is not always feasible. Margins less than 5 mm affect postsurgical strategies and prognoses, and further knowledge of margins smaller than 5 mm is needed. We aimed to systematically review the literature on the impact of surgical resection margins less than 5 mm addressing recurrence and survival in OSCC. A systematic literature search was performed in the PubMed and EMBASE databases identifying studies regardless of publication date that examined margin less than 5 mm, with or without a comparison to size of 5 mm or greater, in patients with OSCC. We assessed the impact on recurrence and survival. We identified six studies ( = 1514 patients); all studies, investigated recurrence, and three ( = 768 patients) evaluated survival. The studies had noteworthy variability in, e.g. follow-up times, anatomical sublocations, T- and N-stage classifications, and outcome measures. Five studies ( = 1387 patients) reported that margins smaller than 5 mm would be safe and would not affect survival or recurrence negatively compared to their own data on larger margins. One study reported that a clear resection margin greater than five mm was necessary to ensure optimal outcomes. The literature showed significant bias and risk issues. In five of the included studies with 1387 patients, we found in selected cases, where margins larger than 5 mm are not possible, a tendency regarding resection margins less than 5 mm to be sufficient for the surgical treatment of patients with primary OSCC. However, the data is insufficient to enable altered recommendations of resection margins in patients with primary OSCC.
手术切缘宽度会影响口腔鳞状细胞癌（OSCC）的复发和生存。通常，清晰切缘的定义是大于 5mm，但由于解剖结构的限制，如骨骼或血管，这一尺寸并不总是可行的。小于 5mm 的切缘会影响术后策略和预后，因此需要进一步了解小于 5mm 的切缘。我们旨在系统地回顾关于手术切缘小于 5mm 对 OSCC 复发和生存影响的文献。在 PubMed 和 EMBASE 数据库中进行了系统的文献检索，无论发表日期如何，只要研究对象是 OSCC 患者，且研究内容涉及小于 5mm 或大于 5mm 的切缘，并对其复发和生存情况进行了分析，就纳入了本次研究。我们评估了切缘对复发和生存的影响。我们共确定了 6 项研究（=1514 例患者）；所有研究均探讨了复发问题，有 3 项研究（=768 例患者）评估了生存情况。这些研究在随访时间、解剖亚部位、T 和 N 分期分类以及结果测量等方面存在显著差异。有 5 项研究（=1387 例患者）报道称，与较大切缘相比，小于 5mm 的切缘是安全的，不会对生存或复发产生负面影响。有 1 项研究报道称，为了确保最佳治疗效果，需要大于 5mm 的清晰切缘。文献中存在明显的偏倚和风险问题。在纳入的 5 项研究（=1387 例患者）中，我们发现，在某些特定情况下，对于无法获得大于 5mm 切缘的患者，小于 5mm 的切缘可能足以作为治疗原发性 OSCC 患者的手术方案。但是，目前的数据还不足以改变原发性 OSCC 患者的切缘建议。
