Ideal Resection Margins in Oral Cavity Cancer

Abstract

Background: To review the evidence and decision-making process on the ideal surgical margins for oral cavity squamous cell carcinoma.

Methods: Pubmed searches incorporating the terms “oral cavity”, “margin” and “resection margin” were used for the literature search. The search period was from the first of January 2008 to the 31st of December 2017. The bibliography of applicable articles available in English were reviewed. Articles specifically about the intraoperative resection and assessment of margins, postoperative surgical margins were reviewed.

Results: The majority of the evidence is based on retrospective data with no clear data particularly for the intraoperative resection margins used, however erring on the side of oncological sound resections the evidence suggests the following. For intraoperative resection margins, gross resection margins of 1.5 cm for oral cavity squamous cell carcinoma are more likely to achieve ≥5 mm margins for early lesions in the oral cavity (Evidence quality very low; weak recommendation). When assessing the actual intraoperative margins they should be assessed from the resected specimen for oral cavity squamous cell carcinoma (Evidence quality low; weak recommendation). For final pathological specimen margins a histopathological margins of ≥5 mm for oral cavity squamous cell carcinoma should definitively be considered clear resection margins (Evidence quality low; weak recommendation).

Conclusions: When deciding on adjuvant therapy based on final histopathological margins one must take into account the biology of the tumor particularly for early stage tumors, as opposed to using a strict definition of ≥5 mm margins as negative margins.