Complete Frozen Section Margins (with Measurable 1 or 5 mm Thick Free Margin) for Cancer of the Tongue: Part 2: Clinical Experience
Complete Frozen Section Margins (with Measurable 1 or 5 mm Thick Free Margin) for Cancer of the Tongue: Part 2: Clinical Experience
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DOI：
10.2310/7070.2009.080055
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发表时间：
2010-02-01
影响因子：
3.4
通讯作者：
Rochette, Linda
中科院分区：
文献类型：
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作者：
Gauthier, Pierre;Audet, Nathalie;Rochette, Linda
目的：通过使用Mohs样技术在口腔舌鳞状细胞癌手术时获得1至5 mm的完全阴性切缘。研究设计：12例患者的病例系列（4例T1，5例T2，2例T3，1例T4）并复习文献。对于前六个病例，在相对较短的时间（20 - 75分钟）内获得了完整的、彩色的精确定位、高质量的冷冻边缘。在切除线1 - 2 mm范围内评价了4个节段。在最后6例病例中，获得了5 mm厚度的完整游离边缘。时间较长（70 - 120分钟），但未超过进行颈淋巴结清扫术所需的时间，1例患者除外。使用手术刀和剪刀的技术意味着稍微多出血，这从来都不是问题。我们没有观察到这12例患者（随访12 - 34个月）复发。结论：文献回顾表明，侵犯和关闭的边缘赋予较高的复发率。我们成功获得了1~2 mm（前6例）和5 mm（后6例）厚、完整、定向、游离的冷冻切缘，无复发，但随访时间较短。如果可能的话，我们希望获得5 mm厚的边缘。延迟获得病理结果是合理的。这种方法应大大减少阳性和关闭边缘的问题，在最后的病理，因此，局部控制率。
Objective: To obtain completely negative margins of 1 to 5 mm at the time of surgery for oral tongue squamous cell carcinoma by using a Mohs-like technique.Study Design: Case series of 12 patients (4 T1, 5 T2, 2 T3, 1 T4) and a review of the literature.Results: For the first six cases, complete, colored for precise orientation, frozen margins of high quality were obtained in a relatively short time (20-75 minutes). Four levels were evaluated within 1 to 2 mm of the line of resection. Obtaining complete free margins for a thickness of 5 mm was done for the last six cases. The time was longer (70-120 minutes) but did not exceed the time necessary to perform the neck dissection, except for one patient. The technique using the scalpel and scissors implied slightly more bleeding, which was never a problem. We have observed no recurrence for these 12 patients (follow-up 12-34 months).Conclusion: The review of the literature demonstrates that invaded and close margins confer a higher recurrence rate. We have obtained 1 to 2 mm (first six patients) and 5 mm (last six patients) thick, complete, oriented, and free frozen margins with success and no recurrence, but the follow-up was short. We prefer to obtain a 5 mm thick margin when possible. The delay to obtain the pathologic result is reasonable. This approach should reduce dramatically the problem of positive and close margins at the final pathology and, consequently, the rate of local control.