A systematic review and meta-analysis of margins in transoral surgery for oropharyngeal carcinoma.
Margins
Oropharyngeal carcinoma
Transoral laser microsurgery
Transoral robotic surgery
Transoral surgery
Journal
Oral oncology
ISSN: 1879-0593
Titre abrégé: Oral Oncol
Pays: England
ID NLM: 9709118
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
24
06
2019
revised:
13
09
2019
accepted:
17
09
2019
pubmed:
24
9
2019
medline:
22
7
2020
entrez:
24
9
2019
Statut:
ppublish
Résumé
The objective of this study was to conduct a systematic review and meta-analysis of the incidence of positive surgical margins after transoral surgery for oropharyngeal carcinoma, as well as the factors associated with positive margins and their impact on local tumor control. An electronic search of English-language literature databases was conducted, and a systematic review was performed in accordance with the PRISMA guidelines. A total of 42 articles were included in the analysis. The overall rate of positive margins using transoral conventional surgery (CTS), transoral laser microsurgery (TLM), or transoral robotic surgery (TORS) was 7.8% in a cumulative total of 3619 patients. A positive margin status was associated with a reduction in local control. Assessment of intraoperative frozen sections was associated with a reduced risk of definitive positive margins, whereas a T4 classification was associated with an increased risk of definitive positive margins. Neither the primary site (the tonsillar fossa versus the base of the tongue), nor the HPV status, were associated with the margin status. The level of heterogeneity between the various studies was very high. The currently used transoral procedures are safe in regard to proper tumor resection and they should continue to be part of the armamentarium of surgical techniques used in head and neck surgery. The very high level of heterogeneity between studies calls for a definition consensus for margin status assessments in transoral surgery.
Sections du résumé
BACKGROUND
The objective of this study was to conduct a systematic review and meta-analysis of the incidence of positive surgical margins after transoral surgery for oropharyngeal carcinoma, as well as the factors associated with positive margins and their impact on local tumor control.
METHOD
An electronic search of English-language literature databases was conducted, and a systematic review was performed in accordance with the PRISMA guidelines.
RESULTS
A total of 42 articles were included in the analysis. The overall rate of positive margins using transoral conventional surgery (CTS), transoral laser microsurgery (TLM), or transoral robotic surgery (TORS) was 7.8% in a cumulative total of 3619 patients. A positive margin status was associated with a reduction in local control. Assessment of intraoperative frozen sections was associated with a reduced risk of definitive positive margins, whereas a T4 classification was associated with an increased risk of definitive positive margins. Neither the primary site (the tonsillar fossa versus the base of the tongue), nor the HPV status, were associated with the margin status. The level of heterogeneity between the various studies was very high.
CONCLUSION
The currently used transoral procedures are safe in regard to proper tumor resection and they should continue to be part of the armamentarium of surgical techniques used in head and neck surgery. The very high level of heterogeneity between studies calls for a definition consensus for margin status assessments in transoral surgery.
Identifiants
pubmed: 31546183
pii: S1368-8375(19)30326-4
doi: 10.1016/j.oraloncology.2019.09.017
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
69-77Informations de copyright
Copyright © 2019 Elsevier Ltd. All rights reserved.