Christopher Pool1, Taelor Weaver2, Junjia Zhu3, David Goldenberg1, Neerav Goyal1. 1. Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Hershey, Pennsylvania, USA. 2. Department of Medical Education, The Pennsylvania State University, Hershey, Pennsylvania, USA. 3. Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University, Hershey, Pennsylvania, USA.
Abstract
OBJECTIVES/HYPOTHESIS: The goal of head and neck cancer surgery is the complete resection of tumor with a cuff of healthy tissue. A 5-mm margin is optimal but not always achievable in the oropharynx. We aimed to identify a consensus of definition and management of close margins for human papilloma virus (HPV)-associated oropharyngeal cancer without other risk factors. STUDY DESIGN: Descriptive survey METHODS: A survey of the American Head and Neck Society (AHNS) was conducted to evaluate the abovementioned objectives by presenting hypothetical scenarios and asking questions regarding management. RESULTS: One-hundred fifty-five AHNS members completed the survey (18% response rate). Close margins were defined as <5 mm, <3 mm, and <1 mm by 27.7%, 32.3%, and 32.3% of respondents. There was no significant difference in margin determination with experience level (P = .186). In an HPV-positive tumor with close margins, 51% chose postoperative observation. The remainder chose adjuvant radiation (22.6%), chemoradiation (1.9%), or re-excision of the wound bed (19.4%). There was no association between postoperative close margin management and experience level (P = .80). CONCLUSION: Heterogeneity exists in the definition and management of close margins in HPV-mediated oropharyngeal carcinoma (OPSCC). Establishing a standard regarding close margins in HPV-mediated OPSCC may allow for the optimization of outcomes and help define best practices. LEVEL OF EVIDENCE: 5 Laryngoscope, 2021.
OBJECTIVES/HYPOTHESIS: The goal of head and neck cancer surgery is the complete resection of tumor with a cuff of healthy tissue. A 5-mm margin is optimal but not always achievable in the oropharynx. We aimed to identify a consensus of definition and management of close margins for human papilloma virus (HPV)-associated oropharyngeal cancer without other risk factors. STUDY DESIGN: Descriptive survey METHODS: A survey of the American Head and Neck Society (AHNS) was conducted to evaluate the abovementioned objectives by presenting hypothetical scenarios and asking questions regarding management. RESULTS: One-hundred fifty-five AHNS members completed the survey (18% response rate). Close margins were defined as <5 mm, <3 mm, and <1 mm by 27.7%, 32.3%, and 32.3% of respondents. There was no significant difference in margin determination with experience level (P = .186). In an HPV-positive tumor with close margins, 51% chose postoperative observation. The remainder chose adjuvant radiation (22.6%), chemoradiation (1.9%), or re-excision of the wound bed (19.4%). There was no association between postoperative close margin management and experience level (P = .80). CONCLUSION: Heterogeneity exists in the definition and management of close margins in HPV-mediated oropharyngeal carcinoma (OPSCC). Establishing a standard regarding close margins in HPV-mediated OPSCC may allow for the optimization of outcomes and help define best practices. LEVEL OF EVIDENCE: 5 Laryngoscope, 2021.
Authors: Roberto N Solis; Nicole I Farber; Nathan Fairman; Nuen T Yang; Sandra L Taylor; Marianne Abouyared; Arnaud F Bewley; D Gregory Farwell; Andrew C Birkeland Journal: Laryngoscope Date: 2022-01-29 Impact factor: 2.970