Adequacy of Surgery of Head and Neck Cancers

Tooba Ather; Ghulam Haider; Asra Taj; Khalil Mehar; Maliha  Ashfaq; Sana Sehar

doi:10.51253/pafmj.v74i2.6261

Authors

Tooba Ather Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi Pakistan
Ghulam Haider Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi Pakistan
Asra Taj Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi Pakistan
Khalil Mehar Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi Pakistan
Maliha Ashfaq Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi Pakistan
Sana Sehar Department of Medical Oncology, Jinnah Postgraduate Medical Centre, Karachi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i2.6261

Keywords:

Adequate surgery, Adequate margins, Carcinomas, Head and neck cancers, Perineural invasion

Abstract

Objective: To assess the proportion of adequate surgery in head and neck cancers.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Medical Oncology Department, Jinnah Postgraduate Medical Center, Karachi Pakistan, from Jan to Dec 2020.

Methodology: One fifty-nine patients aged over 20-65 years, of either gender with a confirmed diagnosis of squamous cell carcinoma of the Head and neck were included. Surgery was performed upfront in all patients without any preoperative/ induction chemotherapy. Data regarding socio-demographic and histopathology findings were noted. Surgery was labelled as inadequate when the number of resected lymph nodes recovered was less than 36, and the margins of the tumour were <5 mm (inadequate).

Results: Of 159 patients, the average age was 46.57±9.73 years. Less than 36 lymph nodes were recovered in 84 patients (52.8%) after neck dissection. A total of 64 patients had inadequate margins (40.3%), 77 had adequate margins (48.4%), and 18 had positive margins (11.3%) on histopathological examination. Overall, 56 patients had adequate surgery (35.2%), and 103 had inadequate surgery (64.7%).

Conclusion: More than half of the patients with Head and neck squamous cell carcinoma had inadequate surgery. Hence, inadequate surgery can lead to poor loco-regional disease control, increased chances of recurrence and overall poor prognosis.

Downloads

Download data is not yet available.

References

NIH. Head and Neck Cancers National Cancer Institute 2020. Internet. Available from: https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet#:~:text=Cancers%20that%20are%20known%20collectively,of%20the%20head%20and%20neck [Accessed on January 22, 2021]

Niaz K, Maqbool F, Khan F, Bahadar H, Ismail Hassan F, Abdollahi M, et al. Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer. Epidemiol Health 2017; 39: e2017009.

https://doi.org/10.4178%2Fepih.e2017009.

Khan SZ, Farooq A, Masood M, Shahid A, Khan IU, Nisar H, et al. Smokeless tobacco use and risk of oral cavity cancer. Turk J Med Sci 2020; 50(1): 291-297.

https://doi.org/10.3906/sag-1809-11.

Cheng C-Y, Sun F-J, Liu C-J. The influence of cervical lymph node number of neck dissection on the prognosis of the early oral cancer patients. J Dent Sci 2020; 15(4): 519-525.

https://doi.org/10.1016/j.jds.2020.06.002.

Clarke P, Radford K, Coffey M, Stewart M. Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016; 130(S2): S176-180. https://doi.org/10.1017/s0022215116000608

Janjua OS, Ahmed W, Qureshi SM, Khan TS, Ahmed A, Alamgir W, et al. Assessment of margins in resection specimens for head and neck malignancies. J Coll Physicians Surg Pak 2013; 23(4): 265-268.

Gokavarapu S, Chander R, Parvataneni N, Puthamakula S. Close margins in oral cancers: implication of close margin status in recurrence and survival of pT1N0 and pT2N0 oral cancers. Int J Surg Oncol 2014; 2014: 545372.

https://doi.org/10.1155%2F2014%2F545372.

Williams MD. Determining Adequate Margins in Head and Neck Cancers: Practice and Continued Challenges. Curr Oncol Rep 2016; 18(9): 54. https://doi.org/10.1007/s11912-016-0540-y.

Sarin R, Somsekhar SP, Kumar R, Pawan G, Sumeet J, Pramoj J, et al. Practical consensus recommendations for tumor margins and breast conservative surgery. South Asian J Cancer 2018; 7(2): 72-78. https://doi.org/10.4103/sajc.sajc_105_18.

Mahvi DA, Liu R, Grinstaff MW, Colson YL, Raut CP. Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies. CA Cancer J Clin 2018; 68(6): 488-505.

https://doi.org/10.3322/caac.21498.

Meier JD, Oliver DA, Varvares MA. Surgical margin determination in head and neck oncology: current clinical practice. The results of an International American Head and Neck Society Member Survey. Head Neck 2005; 27(11): 952-958.

https://doi.org/10.1002/hed.20269.

Hinni ML, Ferlito A, Brandwein-Gensler MS, Takes RP, Silver CE, Westra WH, et al. Surgical margins in head and neck cancer: a contemporary review. Head Neck. 2013; 35(9): 1362-1370.

https://doi.org/10.1002/hed.23110.

Liao CT, Chang JT, Wang HM, Ng SH, Hsueh C, Lee LY, et al. Analysis of risk factors of predictive local tumor control in oral cavity cancer. Ann Surg Oncol 2008; 15(3): 915-922.

https://doi.org/10.1245/s10434-007-9761-5.

Loree TR, Strong EW. Significance of positive margins in oral cavity squamous carcinoma. Am J Surg. 1990; 160(4): 410-414.

https://doi.org/10.1016/s0002-9610(05)80555-0.

Yamada S, Kurita H, Shimane T, Kamata T, Uehara S, Tanaka H, et al. Estimation of the width of free margin with a significant impact on local recurrence in surgical resection of oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2016; 45(2): 147-152.

https://doi.org/10.1016/j.ijom.2015.09.024.

Anderson CR, Sisson K, Moncrieff M. A meta-analysis of margin size and local recurrence in oral squamous cell carcinoma. Oral Oncol 2015; 51(5): 464-469.

https://doi.org/10.1016/j.oraloncology.2015.01.015.

Golusiński W, Golusińska-Kardach E. Current Role of Surgery in the Management of Oropharyngeal Cancer. Front Oncol 2019; 9: 388. https://doi.org/ 10.3389/fonc.2019.00388.

Cheng A, Cox D, Schmidt BL. Oral squamous cell carcinoma margin discrepancy after resection and pathologic processing. J Oral Maxillofac Surg 2008; 66(3): 523-529.

https://doi.org/10.1016/j.joms.2007.08.040.

Zanoni DK, Migliacci JC, Xu B, Katabi N, Montero PH, Ganly I, et al. A proposal to redefine close surgical margins in squamous cell carcinoma of the oral tongue. JAMA Otolaryngol Head Neck Surg 2017; 143(6): 555-560.

https://doi.org/10.1001/jamaoto.2016.4238.

Merz S, Timmesfeld N, Stuck BA, Wiegand S. Impact of lymph node yield on outcome of patients with head and neck cancer and pn0 neck. Anticancer Res 2018; 38(9): 5347-5350.

https://doi.org/10.21873/anticanres.12862.

Ho AS, Kim S, Tighiouart M, Gudino C, Mita A, Scher KS, et al. Metastatic lymph node burden and survival in oral cavity cancer. J Clin Oncol 2017; 35(31): 3601-3609.

https://doi.org/10.1200/jco.2016.71.1176