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Shrinkage depending on the tumor site Nevertheless, it sometimes happens that, the surgeon feels
The degree of shrinkage based on the different tumor sites frustration when noticing that an appropriate surgical margin
was analyzed by three studies. Mistry et al. published a in the operation room presents a considerably decrease in
[16]
study on 27 patients with oral SCC of the tongue and buccal size when is observed by the pathologist. In such cases, it is
mucosa of the oral cavity where examined the distances not surprising that a surgical margin that seems appropriate
pre-resection and post-resection. They reported a greater intra-operatively can be reported as positive or affected
discrepancy of the tongue margins (23.5%) that the buccal in the final histopathologic analysis. Diverse explanations
mucosa margin (21.2%) and a mean loss of 22.7%, however, have been considered in the literature. Thus, the invasive
these results were not statistically significant. In the study of character of oral SCC can lead to occult microscopic margins,
[20]
Cheng et al. on 41 patients with diagnosis of oral SCC the finger extensions or islands of tumor that extend beyond
amount of margin discrepancy between margins measured the clinically visible and palpable tumor, obtaining a margin
[20,23]
intraoperatively and those measured microscopically that is closer than previously expected. Moreover, it
was quantified. The patients were grouped by locations should be kept in mind that malignant molecular changes
obtaining the following statistically significant result: mean may be present even when there are histopathologic normal
margins. Nevertheless, it seems clear that the discrepancy
[26]
discrepancy for group 1 (buccal mucosa, mandibular alveolar observed between clinical and pathological margins is
ridge and retromolar trigone) 71.90%, 53.33% for group 2 most often associated to shrinkage phenomenon after
(maxillary alveolar ridge and palate) and 42.14% for group resection. [23]
3 (oral tongue), with a P value corresponding to 0.0133.
Likewise, El-Fol et al. measured the difference between The aim of this literature review was to identify studies that
[23]
the “in situ” margins and “histopathologic” margins of 61 discussed the tissue shrinkage phenomenon on surgical
patients that underwent resective surgery for oral SCC. margins of resection in patients underwent surgery for
A significant difference in the measurement of resection oral and oropharynx SCC. Only four articles were finally
margin according to the anatomical site was obtained with included in this review according to our search strategy (one
a mean of discrepancy of 66.7% for buccal mucosa, a 35% prospective, one retrospective and two articles not defined).
for the tongue, a 33.3% for the floor mouth, a 16.7% for the All of them reported a discrepancy between surgical margins
retromolar trigone and a 15.4% for the mandibular alveolus. measured intra-operatively and those margins of resection
measured by the pathologist after processing of the surgical
Shrinkage depending on the tumor stage piece. These findings are consistent with those reported by
The percentage of discrepancy in the different studies others authors that observed the phenomenon of margin
analyzed according to the tumor stage was described in only shrinkage at other places of the body.
two studies.
Thus, in a study by Silverman et al. on 199 cutaneous
[27]
The study of Mistry et al. [16] compared the mean shrinkage malignant melanoma reported of a shrinkage of a 15 to 25%
of patients with lower stage tumors (T1 and T2) with the on margins of surgical specimens depending on the patient’s
[28]
mean shrinkage in patients with higher stage tumors age. Likewise, Weese et al. observed in ten patients who
(T3 and T4). The difference between the two groups was underwent colonic resection that resected rectal margin
statistically significant (P < 0.011), with a mean of 3.59 could shrink up to 50% or more after processing histologic
[29]
mm (25.6%) for T1/T2 tumors vs. 1.4 mm (9.2%) for T3/T4 of surgical piece. Siu et al. noted in a study on esophagus
tumors, respectively. However, these results were different carcinoma that exist a different degree of shrinkage of
[20]
to the study presented by Cheng et al. where the mean of the entire specimen from its surgical resection to its final
discrepancy for T1/T2 tumor was 51.48%, and 75% for T3/T4 pathological study. The surgical specimen shrank a 40%
tumors (P = 0.0264). following resection and another 10% after formalin fixation.
However, the first reference regarding to the study of tissue
DISCUSSION
shrinkage on surgical margins of resection in oral cavity and
oropharynx is attributed to Johnson et al. in 1997. In their
[9]
One of the most important prognostic factors respect to experimental study on ten mongrel dogs they reported that
overall survival and local recurrence rates is the status of a shrink of up to 30-50% may be expected in the specimens
surgical margins of resection. [5,25] Indeed, the main goal of of oral cavity and oropharynx and the maximum shrinkage
the resective surgery of the head and neck is the complete occurs immediately after the resection. These results are
removal of the tumor with suitable margins of resection similar to those of the articles analyzed in this review of
[23]
free of disease. However, even at the present day, there human study. In fact, a conclusion shared by all the authors
has not been consensus between researches on what is that specimens of oral SCC are significantly reduced after
constitutes tumor involvement at the resection margin surgical resection. [16,20,23,24]
(including mucosal dysplasia or carcinoma in situ) and
what constitutes an “adequate” margin of resection. [7,8,18] Thus, Mistry et al. published a study on 27 patients with
[16]
Though controversial, it seems reasonable to accept, based oral SCC of the tongue and buccal mucosa where analyzed the
on studies, that 5 mm of healthy tissue around the tumor distances pre-resection and post-resection and reported a mean
should be the minimum acceptable margin size for a clear shrinkage of 3.18 mm (22.7%). However, El-Fol et al. described
[23]
surgical margin in any oral SCC. [7,19] a mean discrepancy between intraoperative margins and
154 Plast Aesthet Res || Volume 3 || May 25, 2016