What is the adequate margin of surgical resection in oral cancer?
Received 2 August 2008; received in revised form 1 October 2008; accepted 15 November 2008. published online 27 January 2009.
Objective
The “adequate surgical margin” has always remained an enigma in the minds of head and neck surgeons. This study systematically analyses the impact of the width of the clear surgical margin on survival in oral cancer.
Study design
A historical cohort of 277 surgically treated patients with oral cancer were followed for a median period of 36 months. Cox proportional hazard models were used to determine the independent effect of the clear surgical margin, in millimeters, on 5-year survival.
Results
Patients with margins of 5 mm or more had a 5-year survival rate of 73% when compared to those with margins of 3 to 4 mm (69%) , 2 mm or less (62%), and involved margins (39%, P = .000). After controlling for confounding variables (age, gender, stage) each 1-mm increase in clear surgical margin decreased the risk of death at 5 years by 8% (HR 0.92; 95% CI 0.86, 0.99; P = .021). Based on this model, patients with positive surgical margins had a 2.5-fold increase in risk of death at 5 years and those with close (≤ 3 mm) margins had a 1.5-fold increase in risk of death (P = 0.076) when compared to patients with margins greater than 3 mm (P = .000).
Conclusions
Survival improves with each additional millimeter of clear surgical margin. This systematic evaluation of surgical margins suggests that an adequate resection in oral cancer should provide a margin of greater than 3 mm on permanent pathology section.
aAssociate Professor, Department of Surgical Oncology, Cancer Care Manitoba, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
bFellow, Pediatric Oral and Maxillofacial Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Canada; Former Fellow, Department of Surgical Oncology, Cancer Care Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
cAssistant Professor, Department of Surgical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
dClinical Epidemiologist and Biostatistician, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
eProfessor and Head of Oral and Maxillofacial Surgery, University of Toronto; Coordinator, Pediatric Oral and Maxillofacial Surgery, Hospital for Sick Children and Bloorview Kids Rehab, Toronto, Canada; Professor, Regea Institute for Regenerative Medicine, University of Tampere, Tampere, Finland; Docent, University of Oulu, Oulu, Finland
Reprint requests: George K.B. Sándor, MD, PhD, FRCDC, FRCSC, FACS, The Hospital for Sick Children, S-525, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
ABSTRACT