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Title: | EVALUATION OF SPECIMEN BASED AND PATIENT BASED RESECTION MARGINS IN HEAD AND NECK MALIGNANCIES |
Authors: | FESLI LATHEEF |
Keywords: | Head and Neck squamous cell carcinoma, Margins of resection, Close margins, Patient and Specimen site margin, Shrinkage on formalin fixation, recurrence, locoregional control. |
Issue Date: | Apr-2022 |
Publisher: | SDUAHER |
Abstract: | BACKGROUND: Surgery is the main modality of treatment in head and neck malignancies. Close or positive margins of resection result in microscopic disease being left behind and carry poor prognosis. Owing to complex anatomy and proximity to vital structures wide margins may not be always possible in this cases it has been a controversy weather to harvest a cut margin for histopathology from the patient site (defect) or from specimen site .This study was taken up to address the above controversy involves histopathological evaluation of a full thickness wedge of resection from the defect (patient site) for distance tumor as well as microscopic disease clearance in 60 patients undergoing surgery for oral cancer with or without extension to pharynx and staged T2 to T4a. OBJECTIVES: 1. To evaluate full thickness slice from the visible closest margin of resection for microscopic disease both from specimen as well as defect in the patient (tumor bed) during resection of primary tumor in head and neck surgeries. 2. To document the distance from margin of primary tumor to closest margin of resection before and after formalin fixation in head and neck squamous cell carcinoma. METHODS: A full thickness slice of tissue was harvested from the margin closest to the tumor both from specimen as well as patient defect site. The distance from the visible margin of tumor to the margin of resection was measured in millimeters intraoperatively, and after resection (Before Formalin Fixation (BFF)) and by xvi histopathology (After formalin fixation (AFF)). The shrinkage of the margin at the surface as well as depth in the muscle along with the third dimension (deepest part) was evaluated during histopathological examination and disease clearance was documented. The patients having Positive or close margins were analyzed with regard to the subsite were the primary tumor was located and Oncological outcome with regard to locoregional control. RESULTS: Majority of our study subjects had tumors involving buccal mucosa 61.7% and oral tongue 16.7% and majority of the patients in our series had locally advanced disease. In our study 1 patient had positive margin and 18 patients had close margins on histopathology. 2 patients had specimen site positive margin and none of the patients had positive margin in (defect) patient site. In our study 33.3% of patients had metastatic cervical lymph nodes and 10% of patients had extra nodal spread. Among 18 patients with close margins, 31.6% patients recurred whereas among patients with adequate margins only 17.5% recurred. Majority of the patients (92%) had tumors with depth of invasion ≥5mm and 25.5% recurred and only 7.7% recurred among patients with depth of invasion <5mm. 1. CONCLUSION: A margin of at least 1cm from outmost part of the tumor to the line of resection before formalin fixation and at least 5mm after formalin fixation is considered adequate in most regions involving squamous cell carcinoma of head and neck. Adequate margins of resection ensure better locoregional control. xvii 2. While evaluating margins of resection for disease clearance, it would be safer to evaluate a full thickness slice of tissue from the specimen (closest margin from the tumor) along with a full thickness slice from the adjoining the defect (patient site). This is all the more important at depth in the muscle tissue. |
URI: | http://172.16.4.202:8080/xmlui/handle/123456789/8132 |
Appears in Collections: | Otorhinolaryngology (ENT) |
Files in This Item:
File | Description | Size | Format | |
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DR. FESLI LATHEEF final p.pdf | 3.34 MB | Adobe PDF | View/Open |
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