Influence of condition of surgical margins on local recurrence and disease-specific survival in oral and oropharyngeal cancer
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INTRODUCTION
The width of margins of clearance in the surgical management of oral and oropharyngeal cancer is widely thought to have an important adverse influence on the subsequent course of the disease.1 Several reports have indicated that the presence of tumour at surgical margins implies a worse prognosis.2., 3. While postoperative radiotherapy decreases the likelihood of local recurrence, it does not reduce the rate to that seen in patients with clear surgical margins.3 Additional work that describes
PATIENTS AND METHODS
Previously untreated patients who presented with oral and oropharyngeal squamous cell carcinoma at two centres (Royal Prince Alfred Hospital Sydney, Australia n=237; and Monklands Hospital, Lanarkshire, Scotland n=95), and managed according to identical treatment protocols were included. Comprehensive data for each patient was entered prospectively onto a computerised database at each centre. Data was collected in Sydney during the period 1987–1997. The opportunity to confirm or refute the
Characteristics of patients, site, and stage distribution of tumours
The Sydney group comprised 237 patients with all survivors having a minimum of one year follow-up and 177 (92%) of survivors having greater than two years follow-up (range 12–120 months). The Lanarkshire cohort comprised 95 patients with a minimum of 15 months follow-up (range 15–60 months). Amongst the 75 patients who were disease free at the last point of contact 64 (87%) had greater than two years follow-up. Previous reports indicate that 78–88% of recurrence events occur within two years of
DISCUSSION
Using multivariate analysis we have failed to demonstrate that the condition of surgical margins had an independent predictive effect on either local recurrence or disease-specific survival. The consistency of findings across two independent samples adds credence to the results. Tumours with more aggressive biology are recognizable in many, but not all, cases by their clinical and pathological presenting features. Metastatic deposits in the regional nodes are clearly the most important, but
CONCLUSIONS
A 1-cm macroscopic margin seems adequate in the surgical management of oral and oropharyngeal carcinoma. For most patients who have unsatisfactory margins despite this therapeutic goal, the biology of the disease influences the subsequent course irrespective of the condition of the surgical margins. The use of wider resection margins is unlikely to influence local recurrence or disease-specific survival, and is likely to have an adverse effect on functional outcome.
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