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. 1996 Jul;74(1):128–132. doi: 10.1038/bjc.1996.327

Do positive resection margins after ablative surgery for head and neck cancer adversely affect prognosis? A study of 352 patients with recurrent carcinoma following radiotherapy treated by salvage surgery.

A S Jones 1, Z Bin Hanafi 1, V Nadapalan 1, N J Roland 1, A Kinsella 1, T R Helliwell 1
PMCID: PMC2074609  PMID: 8679446

Abstract

It is generally accepted by surgeons that failure to eradicate malignant disease at the primary site has an adverse effect on survival. The present study investigates 352 patients with squamous carcinoma of the head and neck treated by primary radical radiotherapy and who subsequently underwent surgical ablation for a recurrent carcinoma. A total of 303 (86%) patients had a negative resection margin and 49 (14%) had a positive resection margin. Oral carcinoma was 1.7 times more likely to be associated with a positive margin than other tumours (P = 0.0292). Actuarial calculations demonstrated that 47% of patients with negative margins and 66% of patients with positive margins developed a primary site recurrence (P = 0.0286). Neck node recurrence occurred in 10% of those patients with negative margins and 12% of patients with positive margins. Patients with positive margins had a significantly poorer survival than those with negative margins (P = 0.022). Multivariate analysis failed to confirm any independent adverse effect from a positive margin. The 5 year tumour-specific survival of patients with a positive margin was poorer by 12% than for those patients with a negative margin. The pattern of failure differed between the two groups, with patients having positive margins tending to die of local recurrence.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bocca E., Pignataro O., Mosciaro O. Supraglottic surgery of the larynx. Ann Otol Rhinol Laryngol. 1968 Dec;77(6):1005–1026. doi: 10.1177/000348946807700602. [DOI] [PubMed] [Google Scholar]
  2. Byers R. M., Bland K. I., Borlase B., Luna M. The prognostic and therapeutic value of frozen section determinations in the surgical treatment of squamous carcinoma of the head and neck. Am J Surg. 1978 Oct;136(4):525–528. doi: 10.1016/0002-9610(78)90275-1. [DOI] [PubMed] [Google Scholar]
  3. Chen T. Y., Emrich L. J., Driscoll D. L. The clinical significance of pathological findings in surgically resected margins of the primary tumor in head and neck carcinoma. Int J Radiat Oncol Biol Phys. 1987 Jun;13(6):833–837. doi: 10.1016/0360-3016(87)90095-2. [DOI] [PubMed] [Google Scholar]
  4. Cook J. A., Jones A. S., Phillips D. E., Soler Lluch E. Implications of tumour in resection margins following surgical treatment of squamous cell carcinoma of the head and neck. Clin Otolaryngol Allied Sci. 1993 Feb;18(1):37–41. doi: 10.1111/j.1365-2273.1993.tb00807.x. [DOI] [PubMed] [Google Scholar]
  5. Harrison D. F. Role of surgery in the management of postcricoid and cervical esophageal neoplasms. Ann Otol Rhinol Laryngol. 1972 Aug;81(4):465–468. doi: 10.1177/000348947208100402. [DOI] [PubMed] [Google Scholar]
  6. Harrison D. The questionable value of total glossectomy. Head Neck Surg. 1983 Nov-Dec;6(2):632–638. doi: 10.1002/hed.2890060204. [DOI] [PubMed] [Google Scholar]
  7. Looser K. G., Shah J. P., Strong E. W. The significance of "positive" margins in surgically resected epidermoid carcinomas. Head Neck Surg. 1978 Nov-Dec;1(2):107–111. doi: 10.1002/hed.2890010203. [DOI] [PubMed] [Google Scholar]
  8. Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. doi: 10.1038/bjc.1977.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Scholl P., Byers R. M., Batsakis J. G., Wolf P., Santini H. Microscopic cut-through of cancer in the surgical treatment of squamous carcinoma of the tongue. Prognostic and therapeutic implications. Am J Surg. 1986 Oct;152(4):354–360. doi: 10.1016/0002-9610(86)90304-1. [DOI] [PubMed] [Google Scholar]
  10. Veronesi U. How important is the assessment of resection margins in conservative surgery for breast cancer? Cancer. 1994 Sep 15;74(6):1660–1661. doi: 10.1002/1097-0142(19940915)74:6<1660::aid-cncr2820740603>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  11. Vikram B., Strong E. W., Shah J. P., Spiro R. Failure at the primary site following multimodality treatment in advanced head and neck cancer. Head Neck Surg. 1984 Jan-Feb;6(3):720–723. doi: 10.1002/hed.2890060303. [DOI] [PubMed] [Google Scholar]

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