High-volume surgeons deliver larger surgical margins in oral cavity cancer

Ellis, Owen G., David, Michael C., Park, Daniel J. and Batstone, Martin D. (2016) High-volume surgeons deliver larger surgical margins in oral cavity cancer. Journal of Oral and Maxillofacial Surgery, 74 7: 1466-1472. doi:10.1016/j.joms.2016.01.026


Author Ellis, Owen G.
David, Michael C.
Park, Daniel J.
Batstone, Martin D.
Title High-volume surgeons deliver larger surgical margins in oral cavity cancer
Journal name Journal of Oral and Maxillofacial Surgery   Check publisher's open access policy
ISSN 1531-5053
0278-2391
Publication date 2016-07
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.joms.2016.01.026
Open Access Status Not Open Access
Volume 74
Issue 7
Start page 1466
End page 1472
Total pages 7
Place of publication Maryland Heights, MO United States
Publisher W.B. Saunders
Collection year 2017
Language eng
Formatted abstract
Purpose

In oral cavity cancer surgery there are many factors that contribute to the surgical margin; thus, the factors determining patient outcomes are still not completely understood. The aim of this study was to determine which variable or variables had the greatest influence on increasing the size of the surgical margin.

Materials and Methods

A retrospective cohort study was conducted at the Royal Brisbane and Women's Hospital of patients who underwent resective surgery for a primary oral cavity cancer from January 1, 2008 through December 31, 2012. The primary outcome variable was the surgical margin, defined as the closest distance between the surgical edge and invasive cancer. A heterogeneous set of predictor variables was identified as potentially affecting the primary outcome variable: demographic, 5 surgical, and 7 histologic variables. The data then underwent statistical analysis using univariable linear regression, and variables that were found to have a statistical association were retained in a non-interaction multivariable model.

Results

This study included 250 patients. The results showed that high-volume surgeons delivered larger surgical margins than low-volume surgeons. The single most important variable associated with larger surgical margins was who performed the resective operation. The following variables also were associated with smaller surgical margins: retromolar trigone location, non–squamous cell carcinomas, perineural invasion, and a lip-split mandibulectomy surgical approach.

Conclusion

There was a strong association between high-volume surgeons and larger surgical margins, supporting the rationalization of oral cavity cancer management in high-volume centers and by high-volume surgeons.

Oral cavity cancer is the sixth most common type of cancer in the world, placing a large burden on the health care system. Most patients are managed surgically, guided by the fundamental principle that complete tumor resection is required for successful treatment.

Involved margins (invasive cancer at the resection site) and close margins (invasive cancer within 5 mm but not involving the resection site) are associated with local disease recurrence and poorer survival rates. Therefore, achieving clear margins (no invasive cancer within 5 mm of the resection site) is highly desirable to improve patient outcomes.

When patients present for treatment, many prognostic factors are already predetermined, such as tumor size, nodal involvement, distant metastases, and patient age. However, the surgical margin is an important independent prognostic factor that clinicians can influence. Therefore, understanding what alters the surgical margin is highly relevant, as patient survival rates could theoretically be improved.

There is very little in the current literature on this subject. Sutton et al4 defined histologic factors that were associated with poorer surgical margins in oral cavity cancer. Perineural invasion, vascular invasion, larger tumor, and tumors that were more aggressive were found to be independently associated with close or involved surgical margins. There is very little known about how specific surgical techniques and clinical practices play a role.

The purpose of this study was to identify which surgical and histologic factors influence the surgical margin in oral cavity cancer surgery. The authors hypothesized that variables existed that could be manipulated to improve the surgical margin. The aims of this study were to 1) measure and compare the data to determine which variables correlated with a statistically larger surgical margin and 2) propose evidence-based methods to increase the surgical margin.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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