Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer
Giancarlo Tirelli MD
Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
Search for more papers by this authorFrancesca Boscolo Nata MD
Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
Search for more papers by this authorAnnalisa Gatto MD
Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
Search for more papers by this authorRossana Bussani MD
Department of Pathological Anatomy and Histopathology, University of Trieste, Cattinara Hospital, Trieste
Search for more papers by this authorGiacomo Spinato MD
Ear, Nose and Throat Department, Rovigo Provincial Hospital, Rovigo, Italy
Search for more papers by this authorSerena Zacchigna MD
Department of Medical Sciences University of Trieste and Cardiovascular Biology, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste
Search for more papers by this authorCorresponding Author
Marco Piovesana MD
Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
Send correspondence to Marco Piovesana, Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Cattinara Hospital, Strada di Fiume 447, 34149, Italy. E-mail: [email protected]Search for more papers by this authorGiancarlo Tirelli MD
Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
Search for more papers by this authorFrancesca Boscolo Nata MD
Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
Search for more papers by this authorAnnalisa Gatto MD
Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
Search for more papers by this authorRossana Bussani MD
Department of Pathological Anatomy and Histopathology, University of Trieste, Cattinara Hospital, Trieste
Search for more papers by this authorGiacomo Spinato MD
Ear, Nose and Throat Department, Rovigo Provincial Hospital, Rovigo, Italy
Search for more papers by this authorSerena Zacchigna MD
Department of Medical Sciences University of Trieste and Cardiovascular Biology, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste
Search for more papers by this authorCorresponding Author
Marco Piovesana MD
Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
Send correspondence to Marco Piovesana, Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Cattinara Hospital, Strada di Fiume 447, 34149, Italy. E-mail: [email protected]Search for more papers by this authorThe authors have no funding, financial relationships, or conflicts of interest to disclose.
Abstract
Objectives
Piecemeal resection provides an innovative conceptual tool for margins surveillance because it entails the intraoperative evaluation of the whole resection margins and not just sample points, which should result in a better control of deep margins compared to en bloc resection. Although it is recognized that the intraoperative use of narrow band imaging (NBI) results in a better control of superficial margins, in this exploratory study we investigated whether NBI and piecemeal resection could be used in combination to improve margin control at both superficial and deep levels. Because piecemeal resection is based on frozen section analysis, we wanted to verify its reliability compared to definitive histological examination.
Methods
The status of resection margins in a group of patients with oral and oropharyngeal cancers treated with NBI and laser CO2 piecemeal resection (group 1) was compared with that of an historical group of patients (group 2) treated with NBI and conventional en bloc resection. In group 1, sensitivity, specificity, and positive and negative predictive values were used to verify the rate of concordance between frozen section and definitive histology.
Results
The difference between deep positive margins in the two groups was statistically significant (P = 0.042). The high sensitivity and specificity (94.6% and 94.7%, respectively) of frozen section analysis also demonstrated its reliability in the examination of larger samples corresponding to the whole margin.
Conclusion
Even if our findings are limited by the small number of patients, we are confident that the combined use of NBI and piecemeal resection could represent an attractive surgical strategy to improve margin control.
Level of Evidence
2b
Laryngoscope, 129:1810–1815, 2019
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