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Surgical Margin Determination in the Era of HPV ‐Positive Oropharyngeal Cancer
Author(s) -
Pool Christopher,
Weaver Taelor,
Zhu Junjia,
Goldenberg David,
Goyal Neerav
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.29533
Subject(s) - medicine , head and neck cancer , cancer , human papilloma virus , margin (machine learning) , surgery , radiation therapy , head and neck , oncology , general surgery , cervical cancer , machine learning , computer science
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 , 131:E2650–E2654, 2021