Surgical Margin Determination in the Era of HPV-Positive Oropharyngeal Cancer

Laryngoscope. 2021 Apr 1. doi: 10.1002/lary.29533. Online ahead of print.

Abstract

Objectives/hypothesis: The goal of head and neck cancer surgery is the complete resection of tumor with a cuff of healthy tissue. A 5-mm margin is optimal but not always achievable in the oropharynx. We aimed to identify a consensus of definition and management of close margins for human papilloma virus (HPV)-associated oropharyngeal cancer without other risk factors.

Study design: Descriptive survey METHODS: A survey of the American Head and Neck Society (AHNS) was conducted to evaluate the abovementioned objectives by presenting hypothetical scenarios and asking questions regarding management.

Results: One-hundred fifty-five AHNS members completed the survey (18% response rate). Close margins were defined as <5 mm, <3 mm, and <1 mm by 27.7%, 32.3%, and 32.3% of respondents. There was no significant difference in margin determination with experience level (P = .186). In an HPV-positive tumor with close margins, 51% chose postoperative observation. The remainder chose adjuvant radiation (22.6%), chemoradiation (1.9%), or re-excision of the wound bed (19.4%). There was no association between postoperative close margin management and experience level (P = .80).

Conclusion: Heterogeneity exists in the definition and management of close margins in HPV-mediated oropharyngeal carcinoma (OPSCC). Establishing a standard regarding close margins in HPV-mediated OPSCC may allow for the optimization of outcomes and help define best practices.

Level of evidence: 5 Laryngoscope, 2021.

Keywords: Oropharyngeal cancer; guidelines; human papilloma virus; margins.