Oncologic Outcomes in Patients with Head and Neck Cancer Improve Incrementally with Surgical Margin Category

by Linda Kossoff •

In patients with head and neck mucosal squamous cell carcinoma (SCC) who underwent a surgical excision, do the oncologic outcomes of close surgical margins differ from clear or involved margins in any study setting?

BOTTOM LINE

There is a stepwise improvement in oncologic outcomes as surgical margin categorically improves from involved to close to clear.

BACKGROUND: The guiding principle in performing surgical resection of head and neck cancer is to achieve wide excision of the tumor to obtain negative margins. Typically defined by their distance from the resected tumor, surgical margins are known to impact prognosis and survival and are categorized as clear, close, or involved.

STUDY DESIGN: Systematic review.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Ariz.

SYNOPSIS: Researchers identified 26 studies that reported oncologic outcomes following excision of primary mucosal head neck squamous cell carcinoma (HNSCC). They then performed a meta-analysis, comparing local recurrence (LR), locoregional recurrence (LRR), and overall survival (OS) in patients with clear, close, and involved margins. Of the 8,435 cases represented, 96% involved the oral cavity. Approximately 68% were staged at T1/T2 and 32% at T3/T4. Overall, five-year OS ranged from 53.3% to 91.2% for clear margins, 37.5% to 70.1% for close margins, and 29.8% to 85.1% for involved margins, respectively. Clear margins were associated with lower incidence of five-year LR relative risk, 95% confidence interval, and higher five-year OS, when compared with close margins. Involved margins had higher incidence of five-year LR and higher incidence of LRR at last follow-up. There was no difference in five-year OS between involved margins when compared with close margins, suggesting that patients with close margins might be considered for escalation of adjuvant therapy. Study limitations included inconsistency of margin definitions and prevalence of oral cavity-related carcinoma cases among studies.

CITATION: Hamman J, Howe CL, Borgstrom M, et al. Impact of close margins in head and neck mucosal squamous cell carcinoma: a systematic review. Laryngoscope. 2022;132:307-321.