Barroso Elisa M, Aaboubout Yassine, van der Sar Lisette C, Mast Hetty, Sewnaik Aniel, Hardillo Jose A, Ten Hove Ivo, Nunes Soares Maria R, Ottevanger Lars, Bakker Schut Tom C, Puppels Gerwin J, Koljenović Senada
Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Front Oncol. 2021 Mar 30;11:628297. doi: 10.3389/fonc.2021.628297. eCollection 2021.
Achieving adequate resection margins during oral cancer surgery is important to improve patient prognosis. Surgeons have the delicate task of achieving an adequate resection and safeguarding satisfactory remaining function and acceptable physical appearance, while relying on visual inspection, palpation, and preoperative imaging. Intraoperative assessment of resection margins (IOARM) is a multidisciplinary effort, which can guide towards adequate resections. Different forms of IOARM are currently used, but it is unknown how accurate these methods are in predicting margin status. Therefore, this review aims to investigate: 1) the IOARM methods currently used during oral cancer surgery, 2) their performance, and 3) their clinical relevance.
A literature search was performed in the following databases: Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar (from inception to January 23, 2020). IOARM performance was assessed in terms of accuracy, sensitivity, and specificity in predicting margin status, and the reduction of inadequate margins. Clinical relevance (i.e., overall survival, local recurrence, regional recurrence, local recurrence-free survival, disease-specific survival, adjuvant therapy) was recorded if available.
Eighteen studies were included in the review, of which 10 for soft tissue and 8 for bone. For soft tissue, defect-driven IOARM-studies showed the average accuracy, sensitivity, and specificity of 90.9%, 47.6%, and 84.4%, and specimen-driven IOARM-studies showed, 91.5%, 68.4%, and 96.7%, respectively. For bone, specimen-driven IOARM-studies performed better than defect-driven, with an average accuracy, sensitivity, and specificity of 96.6%, 81.8%, and 98%, respectively. For both, soft tissue and bone, IOARM positively impacts patient outcome.
IOARM improves margin-status, especially the specimen-driven IOARM has higher performance compared to defect-driven IOARM. However, this conclusion is limited by the low number of studies reporting performance results for defect-driven IOARM. The current methods suffer from inherent disadvantages, namely their subjective character and the fact that only a small part of the resection surface can be assessed in a short time span, causing sampling errors. Therefore, a solution should be sought in the field of objective techniques that can rapidly assess the whole resection surface.
在口腔癌手术中获得足够的切缘对于改善患者预后很重要。外科医生面临着一项微妙的任务，即在依靠视觉检查、触诊和术前影像学检查的同时，实现足够的切除范围，并保障满意的剩余功能和可接受的外观。术中切缘评估（IOARM）是一项多学科协作的工作，可指导实现足够的切除范围。目前使用了不同形式的IOARM，但这些方法在预测切缘状态方面的准确性尚不清楚。因此，本综述旨在研究：1）口腔癌手术中目前使用的IOARM方法；2）它们的性能；3）它们的临床相关性。
在以下数据库中进行文献检索：Embase、Medline、科学引文索引核心合集、Cochrane对照试验中心注册库和谷歌学术（从创刊到2020年1月23日）。根据预测切缘状态的准确性、敏感性和特异性以及减少切缘不足的情况来评估IOARM的性能。如有可用信息，记录临床相关性（即总生存期、局部复发、区域复发、无局部复发生存期、疾病特异性生存期、辅助治疗）。
本综述纳入了18项研究，其中10项针对软组织，8项针对骨组织。对于软组织，缺损驱动的IOARM研究显示平均准确性、敏感性和特异性分别为90.9%、47.6%和84.4%，标本驱动的IOARM研究分别显示为91.5%、68.4%和96.7%。对于骨组织，标本驱动的IOARM研究比缺损驱动的表现更好，平均准确性、敏感性和特异性分别为96.6%、81.8%和98%。对于软组织和骨组织，IOARM均对患者预后产生积极影响。
IOARM可改善切缘状态，特别是标本驱动的IOARM与缺损驱动的IOARM相比具有更高的性能。然而，这一结论受到报告缺损驱动IOARM性能结果的研究数量较少的限制。当前方法存在固有缺点，即其主观性以及在短时间内只能评估切除表面的一小部分，从而导致抽样误差。因此，应在能够快速评估整个切除表面的客观技术领域寻求解决方案。
