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. 2019 Jul;41(7):2159-2166.
doi: 10.1002/hed.25690. Epub 2019 Feb 1.

Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study

Cornelia G F van Lanschot  1   2 , Hetty Mast  3 , Jose A Hardillo  1 , Dominiek Monserez  1 , Ivo Ten Hove  2   3 , Elisa M Barroso  2   4 , Froukje L J Cals  1   2 , Roeland W H Smits  1   2 , Martine F van der Kamp  2   4 , Cees A Meeuwis  1 , Aniel Sewnaik  1 , Rob Verdijk  4 , Geert J L H van Leenders  4 , Vincent Noordhoek Hegt  4 , Tom C Bakker Schut  2 , Robert J Baatenburg de Jong  1 , Gerwin J Puppels  2 , Senada Koljenović  2   4
Affiliations

Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study

Cornelia G F van Lanschot et al. Head Neck. 2019 Jul.

Abstract

Background: Specimen-driven intraoperative assessment of the resection margins provides immediate feedback if an additional excision is needed. However, relocation of an inadequate margin in the wound bed has shown to be difficult. The objective of this study is to assess a reliable method for accurate relocation of inadequate tumor resection margins in the wound bed after intraoperative assessment of the specimen.

Methods: During oral cavity cancer surgery, the surgeon placed numbered tags on both sides of the resection line in a pair-wise manner. After resection, one tag of each pair remained on the specimen and the other tag in the wound bed. Upon detection of an inadequate margin in the specimen, the tags were used to relocate this margin in the wound bed.

Results: The method was applied during 80 resections for oral cavity cancer. In 31 resections an inadequate margin was detected, and based on the paired tagging an accurate additional resection was achieved.

Conclusion: Paired tagging facilitates a reliable relocation of inadequate margins, enabling an accurate additional resection during the initial surgery.

Keywords: intraoperative assessment; oral cavity; relocation; resection margin; specimen driven.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Tags [Color figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Paired tagging method, overview. A, Application of the tags in a pair‐wise manner. B, Wound bed with tags. C, Specimen with corresponding tags. D, Intraoperative specimen‐driven assessment: inadequate margins between tag 2‐4‐5 with thickness of 2 mm. E, Relocation of inadequate margins in the wound bed. (Tag 2‐4‐5 as indicated by the pathologist.) F, Additional resection enclosing the tags and thickness as indicated by pathologist. G, Correlation of additional resection with main resection specimen
Figure 3
Figure 3
Paired tagging, including intraoperative assessment of the resection specimen and correlation of the additional resection with the resection specimen. A, Resection of the tumor of the right processus alveolaris with application of the tags in a pair‐wise manner. B, Wound bed with numbered tags (superficial and deep). C, Resection specimen with corresponding numbered tags. D, Intraoperative specimen‐driven assessment of the resection margins; an inadequate margin was found between tags 2‐5. E, An additional resection based on relocation, enclosing the corresponding tags and thickness, as indicated by the pathologist. F, Assessment of the accuracy of the additional resection based on correlation based on with main specimen
Figure 4
Figure 4
Overview surgico‐pathological workflow based on specimen‐driven intraoperative assessment of resection margins
See this image and copyright information in PMC

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