Specimen-driven intraoperative assessment of resection margins should be standard of care for oral cancer patients

The Erasmus-university Medical Center recently published a review on the methods for intraoperative margin assessment. The review recommends the specimen-driven approach, which corresponds with the MarginGuide-method.

Surgery is the mainstay of treatment for Oral Cancer and aims for complete resection of the tumor with adequate margins, while sparing healthy tissue as much as possible. The definition of margins in oral cancer is provided by the Royal College of pathologists. A clear (or adequate) margin means a distance of <5mm from resection surface to the tumor border, a distance 1-5mm is called ‘close’ and less than 1 is a positive margin. Adequate resection margins lead to higher survival and a marked reduction in local recurrence.

Multiple studies have demonstrated that this aim of adequate tumor resection, is achieved in less than 20% of the surgical procedures. It is evident that for optimal control of resection margin, the surgeon needs additional information. Intraoperative assessment methods for both defect-driven (assessment of sample derived from the wound bed) as specimen-driven (assessment of resection specimen) have been studied extensively.

Specimen-driven has proven to be more efficient in obtaining adequate margins in oral cancer. This approach is also recommended in the latest publication by the American Joint Committee on Cancer (2017).

It also has his limitations. It is time consuming, it requires a dedicated team of head and neck surgeons and a pathologist on stand-by. Another concern is the grossing of freshly excised tissue, which is counterintuitive.

With MarginGuide we aim to make this method available for widespread implementation and improve the number of adequate tumor resections in Oral Cancer.

Read the full review article, including references here: https://onlinelibrary.wiley.com/doi/full/10.1111/odi.13619

Comprehensive, specimen-driven intraoperative assessment procedure by pathologist & surgeon

Reference: Yassine Aaboubout, Ivo ten Hove, Roeland W. H. Smits, Jose A. Hardillo, Gerwin J. Puppels, Senada Koljenovic, Specimen-driven intraoperative assessment of resection margins should be standard of care for oral cancer patients, Oral Diseases 2020