Canzi Pietro, Veneroni Maria Vittoria, Crosetti Erika, Mauramati Simone, Bertino Giulia, Ferraro Ottavia, Succo Giovanni, Benazzo Marco
Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Acta Otorhinolaryngol Ital. 2025 May;45(Suppl. 1):S15-S24. doi: 10.14639/0392-100X-suppl.1-45-2025-N1027.
In oropharyngeal squamous cell carcinoma (OPSCC), proper definition of surgical margins may have substantial impact on oncologic outcomes. Minimally-invasive techniques prioritise reduced morbidity, yet open approaches remain significant due to limited large-scale evidence comparing their outcomes with transoral methods. The purpose of the present systematic review was to assess the incidence of positive margins in OPSCC management based on surgical approach (open transoral) and the subsequent risk of additional treatments.
Medical databases were searched including PubMed, Scopus, EMBASE, and Cochrane Library from January 2000 to August 2024. Data analysis was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and the quality of studies was evaluated using the Newcastle-Ottawa Scale.
Four studies, including 305 patients (126 treated by an open approach, and 179 by transoral surgery), were qualitatively analysed. No significant difference was found in the rates of positive margins (p = 0.422) or need for adjuvant therapy (p = 0.368) between the two approaches. It was not feasible to conduct a meta-analysis due to significant inconsistencies in the reporting of data across the studies included.
Transoral approach is recommended for early-stage OPSCC when adequate exposure is achievable, although its impact on positive surgical margins remains unclear. The management of close or positive margins remains debated due to the oropharyngeal unique anatomy and function, with no clear de-intensification protocol established.
在口咽鳞状细胞癌（OPSCC）中，手术切缘的恰当定义可能对肿瘤学结局产生重大影响。微创技术优先考虑降低发病率，但由于比较其与经口方法结局的大规模证据有限，开放手术方法仍然具有重要意义。本系统评价的目的是基于手术方法（开放手术与经口手术）评估OPSCC治疗中切缘阳性的发生率以及后续进行额外治疗的风险。
检索了2000年1月至2024年8月期间的医学数据库，包括PubMed、Scopus、EMBASE和Cochrane图书馆。按照系统评价和Meta分析的首选报告项目进行数据分析，并使用纽卡斯尔-渥太华量表评估研究质量。
对4项研究进行了定性分析，共纳入305例患者（126例接受开放手术治疗, 179例接受经口手术治疗）。两种手术方法在切缘阳性率（p = 0.422）或辅助治疗需求（p = 0.368）方面未发现显著差异。由于纳入研究的数据报告存在显著不一致，因此无法进行Meta分析。
对于早期OPSCC，在能够实现充分暴露的情况下，推荐采用经口手术方法，尽管其对手术切缘阳性的影响尚不清楚。由于口咽独特的解剖结构和功能，切缘接近或阳性的处理仍存在争议，尚未建立明确的降阶梯治疗方案。
