Volume 134, Issue 2 pp. 717-724
Original Report

How Often is Cancer Present in Oral Cavity Re-resections After Initial Positive Margins?

Kavita Prasad BA

Corresponding Author

Kavita Prasad BA

Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

Send correspondence to Kavita Prasad, BA, Vanderbilt University Medical Center, Department of Otolaryngology, 1211 Medical Center Drive, Nashville, TN 37203. Email: [email protected]

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Rahul Sharma MD

Rahul Sharma MD

Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

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Daniel Habib BA

Daniel Habib BA

Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A.

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Robert Sinard MD

Robert Sinard MD

Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

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Kyle Mannion MD

Kyle Mannion MD

Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

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Sarah Rohde MD

Sarah Rohde MD

Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

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Alexander Langerman MD

Alexander Langerman MD

Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

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James Netterville MD

James Netterville MD

Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

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Eben Rosenthal MD

Eben Rosenthal MD

Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

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James Lewis MD

James Lewis MD

Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

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Michael C. Topf MD

Michael C. Topf MD

Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

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First published: 16 August 2023
Citations: 2
Editor's Note: This Manuscript was accepted for publication on July 25, 2023.

Meeting Information: Triological Society COSM, Boston, MA, USA, May 3–7, 2023.

This research was supported by the NIH/National Institute for Deafness and Communication Disorders (R25 DC020728) and Vanderbilt Clinical Oncology Research Career Development Program—K12 NCI 2K12CA090625-22A1. The authors have no conflicts of interest to disclose.

Abstract

Objective

To evaluate the rate at which carcinoma is present in the re-resection specimen following initial positive margins during head and neck cancer surgery and its impact on oncologic outcomes.

Study Design

Retrospective chart review.

Methods

A single institution retrospective chart review of patients that underwent curative-intent surgery for oral cavity cancer was performed. Final pathology reports were reviewed to identify patients with initial positive margins who underwent re-resection during the same operation. Initial positive margin was defined as severe dysplasia, carcinoma in situ (CIS), or carcinoma. Cox proportional hazards and Kaplan–Meier analyses were used to assess for associations with survival outcomes.

Results

Among 1873 total patients, 190 patients (10.1%) had initial positive margins and underwent re-resection during the same surgery. Additional carcinoma, CIS, or severe dysplasia was found in 29% of re-resections, and 31% of patients with initial positive margins had final positive margins. Half of the patients with a final positive margin had a positive margin at an anatomic site different than the initial positive margin that was re-resected. The median follow-up was 636 days (range 230–1537). Re-resection with cancer and final positive margin status was associated with worse overall survival (OS; p = 0.044 and p = 0.05, respectively). However, only age, T4 disease, and surgery for recurrent oral cavity cancer were independently associated with OS (p < 0.001, p = 0.005, and p = 0.001, respectively).

Conclusions

Fewer than a third of oral cavity re-resections contain further malignancy, which may suggest that surgeons have difficulty relocating the site of initial positive margin. Final positive margins are often at anatomic sites different than the initial positive margin.

Level of Evidence

4 Laryngoscope, 134:717–724, 2024

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