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[22]
INTRODUCTION The population, intervention, control and outcomes
(PICO) question that guided this review was as follows: is the
According to the last report of World Health Organization effect of tissue shrinkage phenomenon a factor to take into
in 2014, cancer of the oral cavity and pharynx constitute, account in the surgical treatment of oral and oropharyngeal
in combination, the seventh most common cancer in the squamous cell carcinoma?
world and the ninth most common cause of death by cancer.
Its annual incidence is estimated about 529,000 new cases/ Search strategy
year. Two-thirds of theses cases are described in developing A combination of controlled terms Medical Subjects
[1]
countries. The squamous cell carcinoma (SCC), with a high Headings (MeSH) and keywords were used as strategy of
[2]
morbidity and mortality, constitutes the most common search. The search terms used, where “[mh]” represented the
entity in the upper aerodigestive tract in approximately MeSH terms and “[tiab]” represented title and/or abstract,
90% of cases. Its survival rate at 5 years, for most countries, were: “carcinoma, squamous cell” [MeSH Terms] OR “mouth
is around 50%. Numerous clinical and histopathologic neoplasms” [MeSH Terms] OR “oropharynx neoplasm”
[2]
factors have been considered as prognostic at the SCC. [3,4] [MeSH Terms] OR “oral cancer” [Title/Abstract] OR “oral
Among them, one of the most relevant, with respect to the neoplasm” [Title/Abstract] OR “oral tumour” [Title/Abstract]
overall survival and recurrence rate, is the status of surgical OR “oropharynx cancer” [Title/Abstract] OR “oropharynx
margin of resection free of disease. [5-8] However, although tumours” [Title/Abstract] OR “squamous cell carcinoma”
one goal in the oncologic surgery is the complete removal [Title/Abstract]) AND (“tissues” [MeSH Terms] OR “tissues”
of the tumor with an appropriate margin of security and [Title/Abstract] OR “tissue” [Title/Abstract] OR “margin”
less aesthetic and functional impact; in the head and neck [Title/Abstract] OR “surgical margin” [Title/Abstract] OR
region, due to its three-dimensional characteristics and the “resection margin” [Title/Abstract]) AND (shrinkage [All
presence of noble structures, the obtaining of appropriate Fields] OR “retraction” [Title/Abstract] OR “shrink” [Title/
limits of resection constitutes, on occasions, a real challenge Abstract].
for the surgeon. [9,10]
In addition, to identify supplementary articles, the related
Nevertheless, since 1978 when Looser et al. defined the citations function of Pubmed was used. Likewise, a manual
[5]
term “positive surgical margin”, diverse concepts such as search based on an equivalent search strategy to that used in
“close margins”, “involved margins” or “clear margins”, the Pubmed was performed. Some of the most relevant head
among others, have been introduced in the literature and neck, oral and maxillofacial and plastic surgery-related
without a general consensus. [10-13] In fact, even today, there journals were consulted, including: International Journal of
are no universal guidelines that permit different pathologists Oral and Maxilofacial Surgery; Journal of Oral and Maxillofacial
to adopt the same histologic criteria regarding to surgical Surgery; Journal of Craniomaxillofacial Surgery; Journal of
margin. [5,14-17] This lack of agreement on what should Maxillofacial Surgery; British Journal of Oral and Maxillofacial
constitute an “adequate” or “safe” margin of resection [8,18] Surgery; Oral Surgery, Oral Medicine, Oral Pathology and Oral
have led to each pathology department to classify surgical Radiology and Endodontology; Head and Neck; Oral Oncology and
margins according to its own experience or internal Journal of Plastic, Reconstructive and Aesthetic Surgery.
guidelines, thereby hampering the comparison of the results
obtained in the different studies and its extrapolation to the Eligibility criteria
clinical practice. A recent systematic review concluded that Articles were included in this systematic review if they
[14]
a histopathologic margin of at least 5 mm is the minimum met the following inclusion criteria: prospective and
acceptable margin size that should be achieved in any oral retrospective studies, cohort, cross-sectional and case-
[19]
SCC. Currently, following the surgical standard, it has control studies or human clinical trials that discussed:
been established that a macroscopic surgical margin of 1 to (1) the phenomenon of retraction or tissue shrinkage on
2 cm obtained intra-operatively is enough extent to obtain surgical margins of resection; (2) the difference between
a free-tumor margin (5 mm at present) in the oral cavity measurements taken in the operation room and those
and oropharynx. [3,19-21] Nevertheless, sometimes it happens reported by the pathologist on the surgical specimen; or
that, despite surgical margins measured by the surgeon (3) the influence of histopathologic processing on resection
intra-operatively seem appropriate, a notable discrepancy is margins of surgical pieces in patients underwent surgery for
observed when are analyzed by the pathologist under the oral or oropharyngeal SCC.
microscope. Faced with this dilemma, a review of the best
available evidence in the literature regarding to the tissue On the contrary, single case reports, animal or in vitro
shrinkage phenomenon observed on surgical margins of studies, literature reviews, letters, editorial, correspondence
resection in patients with oral and oropharyngeal SCC was or those studies in which phenomenon of shrinkage was not
carried out. centered on surgical margin were excluded.

METHODS Screening process and data extractions
The screening process was conducted by one reviewer
An electronic literature search was conducted by one (D.G.B). The titles and abstracts were firstly analyzed.
reviewer (D.G.B) in Pubmed (Medline) database, up to The second step consisted of a selection of those articles
January 2016. No language or date restrictions were applied. related with the PICO question. All articles selected were
Plast Aesthet Res || Volume 3 || May 25, 2016 151