Will the mininvasive approach challenge the old paradigms in oral cancer surgery?

Eur Arch Otorhinolaryngol. 2017 Mar;274(3):1279-1289. doi: 10.1007/s00405-016-4221-0. Epub 2016 Aug 4.

Abstract

In the genome era, the achievement of a safe and complete resection of oral cancers remains a challenge for surgeons. Margin length at histopathological examination is still considered the main indicator of oncological radicality. However, this parameter is fraught by major limitations. Cancer aggressiveness, and in particular its ability to spread in the surrounding tissue, most probably influences loco-regional control and prognosis more than margin length. Unfortunately, no molecular markers are currently available to predict tumor aggressiveness pre-operatively. However, additional histopathological parameters, beside margin length, could be considered to better stratify oral tumors, including depth of invasion (DOI), perineural invasion or composite scores. Recent advances in laser technology have established a novel surgical trend toward a minimalist approach, named transoral laser microsurgery (TLM). TLM provides a local control rate comparable to the one achieved by larger resections if the margin appears disease free, independent from its length. In addition, the clinical availability of innovative optical technologies, such as narrow band imaging (NBI) or autofluorescence, allows more precise and tailored resections, not simply based on clinical observation and ruler measurement. This review will propose the possible implementation of novel procedures toward a mini-invasive surgical approach, providing a satisfactory control rate but significantly improving the quality of life of the patients compared to conventional surgery.

Keywords: Optical imaging; Oral squamous cell carcinoma; Quality of life; Shrinkage of specimens; Surgical margins; Transoral laser microsurgery.

Publication types

  • Review

MeSH terms

  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / surgery
  • Diagnostic Imaging
  • Humans
  • Intraoperative Care
  • Laser Therapy*
  • Mandible / diagnostic imaging
  • Mandible / surgery
  • Margins of Excision
  • Microsurgery*
  • Minimally Invasive Surgical Procedures*
  • Mouth Neoplasms / pathology
  • Mouth Neoplasms / surgery*
  • Preoperative Care
  • Quality of Life