Goldschmidt Stephanie
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States.
Front Vet Sci. 2022 Mar 22;9:830258. doi: 10.3389/fvets.2022.830258. eCollection 2022.
Ameloblastoma is a benign epithelial odontogenic tumor with the capacity to aggressively invade the surrounding bone. Surgical removal of the tumor can result in extended disease-free interval (cure). However, controversy surrounds the most appropriate surgical margin required to prevent local recurrence while simultaneously minimizing morbidity. excisional surgery carries the risk of major complications such as mandibular drift, hemorrhage, and oronasal fistula formation. Conservative therapy without a safety margin reduces potential morbidity but is likely to result in local recurrence. No reliable rate, nor time to recurrence, is documented but may be as high as 91% with conservative therapy. Conversely, surgery with a 10- to 20-mm margin is associated with a 0-4.6% recurrence rate. There is no documented difference in the recurrence rate with a 10- vs. 20-mm margin. The correlation of the histologic margin with the recurrence rate following excisional surgery has not determined a required histologic safety margin. Rather, no local recurrence occurs despite narrow or incomplete margins. Thus, pathologic margins > 0 mm may be sufficient to prevent local recurrence or recurrence may be protracted. Accordingly, a narrow (5-10 mm) gross surgical margin may be the most appropriate. Additional research is required for confirmation, and only level 4 evidence on safety margins has been achieved thus far. Future work should focus on defining the extension of neoplastic cells past the demarcation of ameloblastoma on variable diagnostic imaging modalities as well as determining the recurrence rate with various surgical and histologic safety margins.
成釉细胞瘤是一种良性上皮性牙源性肿瘤，具有侵袭周围骨质的能力。手术切除肿瘤可实现较长的无病生存期（治愈）。然而，对于预防局部复发同时将发病率降至最低所需的最合适手术切缘，仍存在争议。切除手术存在诸如下颌骨移位、出血和口鼻瘘形成等重大并发症的风险。没有安全切缘的保守治疗可降低潜在发病率，但可能导致局部复发。虽无可靠的复发率记录，也无复发时间记录，但保守治疗的复发率可能高达91%。相反，切缘为10至20毫米的手术复发率为0至4.6%。切缘10毫米与20毫米的复发率并无记录显示有差异。切除手术后组织学切缘与复发率的相关性尚未确定所需的组织学安全切缘。相反，尽管切缘狭窄或不完整，但并未发生局部复发。因此，病理切缘>0毫米可能足以预防局部复发，或者复发可能会延迟。因此，较窄（5至10毫米）的大体手术切缘可能是最合适的。需要进一步研究予以证实，目前仅获得了关于安全切缘的4级证据。未来的工作应侧重于确定在各种诊断成像模式下肿瘤细胞超出成釉细胞瘤边界的范围，以及确定各种手术和组织学安全切缘的复发率。
