a1 Division of Otolaryngology, Head and Neck Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
a2 Division of Pathology, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
a3 Division of Oral and Maxillofacial Surgery, Head and Neck Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
Background: Traditionally, a 1-cm surgical resection margin is used for early oral tongue tumours.
Methods: All tumour stage one (n = 65) and stage two (n = 13) oral tongue cancers treated between January 1999 and January 2009 were followed for a median of 38 months (minimum 12 months). The sites of close and involved margins were histologically reviewed.
Results: Involved and close margins occurred in 14 and 55 per cent of cases, respectively. The number of involved vs clear or close margins was equivalent in tumour stage one (90 vs 82 per cent), node-negative (100 vs 84 per cent) and perineural or lymphovascular invasion (20 vs 21 per cent) cases. Close or involved margins were similarly likely to be posterior (59 per cent) as anterior (41 per cent, p = 0.22), lateral (57 per cent) as medial (43 per cent, p = 0.34), and mucosal (59 per cent) as deep (41 per cent, p = 0.22). Local recurrence occurred in 28 per cent of cases at a median of 12 months, and was more likely in cases with involved (50 per cent) than clear or close margins (25 per cent, p = 0.10). Disease-free survival was worse in involved margins cases (p = 0.002).
Conclusion: Involved margins are common in early tongue tumours, and are associated with increased local recurrence and worse survival. Close or involved margins occur in all directions and all tumour types. A wider margin may be justified.
(Accepted August 05 2011)
(Online publication January 19 2012)
Dr T A Iseli takes responsibility for the integrity of the content of the paper
Competing interests: None declared