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Should Margin Sampling Be Obtained from the Specimen or from the Resection Bed in Oral Cavity Cancer?

  • Jonathan P. GiurintanoEmail author
  • Patrick K. Ha
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

Historically, the Halstedian oncologic principle of achieving en bloc tumor resection with at least a 5 mm negative margin has been the goal in the surgical management of oral cavity malignancies. While this sounds straightforward in theory, in practice, achieving negative surgical margins is complicated by the balance of resecting sufficient tissue for complete oncologic resection while preserving sufficient tissue to maintain function. Most surgeons rely on intraoperative frozen margin assessment to help guide intraoperative decision making. There are two main approaches to obtaining margins in patients undergoing oral cavity cancer resection: defect-driven, where the margin is obtained from the tumor bed, and specimen-driven, where the margin is obtained from the en bloc resection. Comparing these techniques, the published data of the one randomized control trial and multiple large institutional reviews are concordant: margin sampling obtained from the tumor bed is less reliable than sampling from the tumor specimen and has low sensitivity detecting true positive margins. In our review of the literature for this topic, it appears that the question is transitioning from “should margin sampling be obtained from the specimen or from the resection bed in oral cavity cancer?” to “should margin sampling be obtained in oral cavity cancer?”

Keywords

Oral Cavity Margin Frozen 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Otolaryngology—Head and Neck SurgeryUCSF Medical CenterSan FranciscoUSA
  2. 2.Department of Otolaryngology—Head and Neck SurgeryGeorgetown University Medical CenterWashington, DCUSA

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