PREOPERATIVE ULTRASONOGRAPHIC DETERMINATION OF DEEP SURGICAL MARGIN IN SQUAMOUS CELL CARCINOMA OF BUCCAL MUCOSA.

Corresponding Author:
Pranay Gaikwad,
Professor of Surgery and HOD,
Department of General Surgery Unit 1-
Head and Neck Oncosurgery,
Christian Medical College,
Vellore-632004, Tamilnadu, India.
E-mail: pranay@cmvellore.ac.in

ABSTRACT

BACKGROUND

Surgical margins are a modifiable factor in the management of buccal cancers. The deep margin is often compromised in favour of  aesthetics of a preserved skin flap over the cheek. We wanted to study the impact of deep margin assessment by ultrasound, subsequent surgical clearance, and local recurrence rates at 2 years of follow up in carcinoma of buccal mucosa.

METHODS

This was a combined prospective and retrospective single institution study of patients with buccal carcinoma assessed by ultrasound and clinical examination, conducted to test the histopathological adequacy, the need for reconstructive procedures and for adjuvant therapy, in 15 patients with the buccal squamous cell carcinoma by sonographic determination of tumour-skin distance. The findings were compared with those from the historical controls. In the study group, the overlying skin was excised if on sonographic assessment, tumour-skin distance was <13 mm, to achieve adequate oncological clearance while maintaining the cutaneous viability.

RESULTS

Overlying skin was excised in all the study patients (mean tumour-skin distance: 5.32 mm). None of the control group patients had undergone skin excision. In the study group, 86.6% of patients underwent flap reconstructions as compared to 46.6% in the control group. The deep margins were adequate in 85.7% of the study group patients and in 13.3% of the control group patients (p <0.001). All patients in the control group required adjuvant therapy due to adverse histopathological factors. During the follow up period of 2 years, the disease-free survival for both groups was comparable (log-rank test; p= 0.838)

CONCLUSIONS

The deep margin clearance is significantly improved by sonographic assessment as compared to the clinical judgment of skin involvement. Skin resection adds to the magnitude of surgery, but fewer patients will need receiving of adjuvant radiotherapy. The benefit on locoregional recurrence will require a study with larger numbers.