Département d'ophtalmologie et d'oto-rhino-laryngologie - chirurgie cervico-faciale, Faculté de Médecine, Université Laval, Québec, QC, Canada.
Département de chirurgie, Service d'oto-rhino-laryngologie - chirurgie cervico-faciale, CISSS de l'Outaouais, Centre affilié universitaire avec l'Université McGill, Gatineau, QC, Canada.
J Otolaryngol Head Neck Surg. 2024 Jan-Dec;53:19160216241278653. doi: 10.1177/19160216241278653.
The routine assessment of intraoperative margins has long been the standard of care for oral cavity cancers. However, there is a controversy surrounding the best method for sampling surgical margins. The aim of our study is to determine the precision of a new technique for sampling tumor bed margins (TBMs), to evaluate the impact on survival and the rate of free flap reconstructions.
This retrospective cohort study involved 156 patients with primary cancer of the tongue or floor of the mouth who underwent surgery as initial curative treatment. Patients were separated into 2 groups: one using an oriented TBM derived from Mohs' technique, where the margins are taken from the tumor bed and identified with Vicryl sutures on both the specimen and the tumor bed, and the other using a specimen margins (SMs) driven technique, where the margins are taken from the specimen after the initial resection. Clinicopathologic features, including margin status, were compared for both groups and correlated with locoregional control. Precision of per-operative TBM sampling method was obtained.
A total of 156 patients were included in the study, of which 80 were in TBM group and 76 were in SM group. Precision analysis showed that the oriented TBM technique pertained a 50% sensitivity, 96.6% specificity, 80% positive predictive value, and an 87.5% negative predictive value. Survival analysis revealed nonstatistically significant differences in both local control (86.88% vs 83.50%; = .81) as well as local-regional control (82.57% vs 72.32%; = .21). There was a significant difference in the rate of free flap-surgeries between the 2 groups (30% vs 64.5%; < .001).
Our described oriented TBM technique has demonstrated reduced risk of free flap reconstructive surgery, increased precision, and similar prognostic in terms of local control, locoregional control, and disease-free survival when compared to the SM method.
长期以来，对口腔癌进行术中切缘评估一直是常规护理标准。然而，对于采样手术切缘的最佳方法存在争议。我们的研究目的是确定一种新的肿瘤床切缘（TBM）采样技术的精确性，评估其对生存和游离皮瓣重建率的影响。
本回顾性队列研究纳入了 156 名接受舌或口底原发性癌症手术作为初始治愈性治疗的患者。患者分为两组：一组采用源自 Mohs 技术的定向 TBM 技术，即从肿瘤床获取边缘，并在标本和肿瘤床上用 Vicryl 缝线标记；另一组采用标本切缘（SM）驱动技术，即从初始切除后的标本获取边缘。比较两组的临床病理特征，包括切缘状态，并与局部区域控制相关联。获得术中 TBM 采样方法的精度。
共纳入 156 例患者，其中 TBM 组 80 例，SM 组 76 例。精度分析表明，定向 TBM 技术的敏感性为 50%，特异性为 96.6%，阳性预测值为 80%，阴性预测值为 87.5%。生存分析显示，局部控制（86.88% vs 83.50%； = .81）和局部区域控制（82.57% vs 72.32%； = .21）差异均无统计学意义。两组游离皮瓣手术率差异有统计学意义（30% vs 64.5%； < .001）。
与 SM 方法相比，我们描述的定向 TBM 技术具有降低游离皮瓣重建手术风险、提高精度以及在局部控制、局部区域控制和无病生存率方面相似的预后。
