Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Department of Oral and Maxillofacial Surgery, Saarland University Hospital, Kirrberger Straße, 66424, Homburg, Germany.
Clin Oral Investig. 2024 May 20;28(6):327. doi: 10.1007/s00784-024-05711-5.
Surgical resection is a key component of the treatment of head and neck cancer and the achievement of free surgical margins are essential for the patients' outcome in terms of survival. While there is a general recommendation for a free resection range of 5 mm, up to date, there is a lack of investigations on the quality of tumor resection in dependence of affected subsite and tumor stage. In the presented study, predictors for the achieved resection margins in surgically treated oral squamous cell carcinomas were analyzed.
A cohort of 567 patients was included in a retrospective analysis and resection status with exact margin ranges were analysed. Tumor stage, affected subsite and the results of the intraoperative frozen section analysis were assessed. Primary endpoint was the achieved resection margin in mm, secondary endpoints were overall and progression-free survival.
The observed mean values of minimal resection margins differed significantly between the investigated subsites (p = 0.042),pathological tumor stages (p < 0.001) and in tumors which demonstrated perineural infiltration (Pn1, p = 0.002). Furthermore, there was a significant impact of the results of the intraoperative frozen section analysis on progression-free and overall survival (p < 0.001).
Our data clearly indicate that resection status differs between tumors of different subsites and tumor stages.
Clinical procedures should be adapted in order to achieve similar certainty in all resections, and, thus to improve patients' outcome.
手术切除是头颈部癌症治疗的关键组成部分，实现无肿瘤切缘是患者生存预后的关键。虽然一般建议无肿瘤切缘的切除范围为 5mm，但迄今为止，尚缺乏关于肿瘤切除质量与受影响的亚部位和肿瘤分期之间关系的研究。在本研究中，分析了手术治疗的口腔鳞状细胞癌的切除边缘的预测因子。
对 567 例患者进行回顾性分析，并分析了确切的切缘范围。评估了肿瘤分期、受影响的亚部位以及术中冰冻切片分析的结果。主要终点是达到的切除边缘（mm），次要终点是总生存和无进展生存。
观察到的最小切除边缘的平均值在研究的亚部位（p=0.042）、病理肿瘤分期（p<0.001）和有神经周围浸润（Pn1，p=0.002）的肿瘤之间存在显著差异。此外，术中冰冻切片分析的结果对无进展生存和总生存有显著影响（p<0.001）。
我们的数据清楚地表明，不同亚部位和肿瘤分期的肿瘤切除状态不同。
临床程序应进行调整，以确保所有切除都具有相同的确定性，从而改善患者的预后。
