Acta Otorhinolaryngologica Italica最新文献

Objective: Surgery remains a cornerstone in treatment of sinonasal malignancies, but the prognostic role of margin status is controversial. This systematic review and meta-analysis evaluated the prognostic significance of surgical margins in sinonasal cancer and their impact on survival, alongside key challenges in its evaluation.

Methods: A systematic search in PubMed, Scopus, and Web of Science identified 64 studies (34,120 patients).

Results: The overall margin infiltration rate was 33.2%, varying widely across studies (4.5-88.2%) and histotypes, and was the highest in adenoid cystic carcinoma (ACC, 61.5%). Meta-analysis of 31 studies showed positive margins were associated with worse survival (overall survival, odds ratio [OR] 2.61; disease-specific survival, OR 5.89; disease-free survival, OR 4.40). Squamous cell carcinoma, olfactory neuroblastoma, and mucosal melanoma had the strongest correlation with margin status, while for ACC and adenocarcinomas statistical significance was not reached. High heterogeneity was noted across studies, alongside inconsistent margin classification, distance thresholds, and use of frozen sections, limiting cross-study comparability.

Conclusions: This study confirms the prognostic value of surgical margins, but underscores the urgent need for standardised definitions to improve prediction of oncologic outcomes and clinical decision-making.

Objective: Major salivary gland malignancies (MSGM) are a rare and heterogeneous group of tumours accounting for 1-5% of all head and neck cancers. When feasible, surgical removal with negative margins is the preferred treatment, reserving adjuvant radiotherapy for adverse clinicopathological features such as high-grade, advanced-stage, extranodal extension, lympho-vascular invasion, perineural invasion, and positive margins. This systematic review aims to evaluate the current literature on the definition of negative and close margins for MSGM, their impact on loco-regional recurrence (LRR), disease-free (DFS), and overall survival (OS), and their implications in the choice of multimodal therapies.

Methods: An online search of articles published between 2004 and 2024 was carried out using PubMed via a PICO search strategy for qualitative questions and written following the PRISMA statement guidelines. The following parameters were evaluated: definition of free and close margins, and their impact on local control.

Results: The initial search yielded 158 articles. Following the application of inclusion and exclusion criteria, 30 full-text publications were reviewed. All studies were retrospective. A total of 15,985 patients who underwent surgery were considered. Margin involvement ranged widely among the studies from 14.3% to 65.4%. Five out of 30 studies reported no data about association between margins and LRR, DFS, and OS. Twenty of 25 studies reported a significant correlation between positive margins and oncological outcomes regardless of the histological types, while 5 focused on high-stage cancers or more aggressive histotypes and described no association between margin status and oncological outcomes. Nine of 30 studies described close margins in the absence of a univocal definition of threshold for close vs. negative margins. Most studies did not report a significant correlation between close margins and oncological outcomes.

Conclusions: Surgical resection achieving negative margins is recommended for MSGM. Positive margin is widely considered an adverse clinicopathological feature and performing adjuvant radiotherapy has documented survival benefits. A consensus involving a definition of close margin is missing, although further treatment is not recommended, preferring a watch-and-wait approach in presence of close margins.

Introduction: Non-melanoma skin cancers (NMSCs), including basal (BCC) and squamous cell carcinoma (SCC), are the most prevalent malignancies affecting the skin, with the head and neck region being the most common site of involvement. Surgical excision remains the primary treatment modality. The role of surgical margins in the treatment of skin SCC and BCC of the head and neck remains a subject of ongoing debate. Clear definitions and guidelines regarding adequate surgical margins, as well as their impact on recurrence rates and overall outcomes, are critical for improving clinical management. This systematic review aims to evaluate the current literature on the definitions of surgical margins for SCC and BCC of the head and neck, as well as their impact on local recurrence, disease free survival, and other patient-centred outcomes.

Materials and methods: We conducted a systematic review following the PRISMA guidelines. A comprehensive search was performed across multiple databases, including PubMed and Scopus, for studies published up to December 2024. Eligible studies included those that reported on surgical margin definitions, surgical outcomes, and recurrence rates for SCC and BCC of the skin in the head and neck region. Data were extracted and analysed for margin size and oncological outcomes.

Results: Following the application of inclusion and exclusion criteria, 30 studies have been retrieved for qualitative synthesis. Of these, 12 studies focused on SCC only, 14 on BCC only, and 4 on mixed histologies. Margin involvement rates ranged widely across the studies included (5-56%) as did thelocal recurrence rate (0-20%). This is associated with a variability of the surgical margin both for SCC and BCC, and of the definition of margin as close/negative at final pathology. Most studies do not define a threshold for close vs. negative margins at final pathology. All studies but one reported a significant correlation between positive margins and oncological outcomes, with particular regards to local recurrence.

Conclusions: The findings highlight a lack of consensus on the optimal surgical margins for SCC and BCC of the head and neck, suggesting that margins may need to be individualised based on tumour characteristics, location, and patient factors. In particular, the anatomical complexity of the head and neck region suggests to separately address different high-risk areas as nose/midface, periauricular, and periocular with specific recommendations also concerning clinical margins.

Objective: Hypopharyngeal squamous cell carcinoma is an aggressive malignancy with poor prognosis due to frequently late-stage presentation and intrinsic anatomical complexity. Surgery remains a key treatment, and resection margins are crucial for local control and survival. However, achieving adequate margins is challenging due to submucosal tumour spread and common "skip lesions". This systematic review examines the impact of positive and close margins on oncological outcomes and their role in treatment planning.

Methods: Following PRISMA guidelines, we included studies on adult hypopharyngeal cancer patients undergoing surgical treatment, including transoral laser microsurgery, transoral robotic surgery and open resections. The primary outcome was overall survival (OS); secondary outcomes included disease-free survival (DFS), disease-specific survival (DSS), and local control. A systematic search of PubMed, EMBASE, and Cochrane databases from 2000 to 2024 was conducted, with eligible studies screened based on strict inclusion criteria. Random-effect meta-analysis was used to estimate the pooled hazard ratio (HR) and relative 95% confidence interval (CI).

Results: From an initial pool of 2,681 articles, 157 full-text studies were reviewed, and 7 met inclusion criteria. Data on 619 patients (mean age, 60.9 years) were analysed, all from retrospective studies. Among these, 17% received neoadjuvant chemotherapy, while 94% underwent adjuvant treatment due to positive margins or other adverse features. A meta-analysis found no statistically significant impact of positive or close margins on OS, DSS, or DFS when compared to negative ones. OS had an HR of 1.78 (95%CI: 0.79-4.04, p = 0.17), DFS HR 1.43 (95%CI: 0.82-2.49, p = 0.21), and DSS HR 1.31 (95%CI: 0.42-4.05, p = 0.42).

Conclusions: This review underscores the challenges of achieving optimal margins in hypopharyngeal cancer surgery. While positive and close margins increase the risk of recurrence, their impact on survival remains unclear, emphasising the need for standardised margin assessment and tailored treatment strategies. The significant submucosal spread and presence of skip lesions necessitates a multidisciplinary approach. Future research should refine surgical techniques, improve intraoperative margin assessment, and optimise adjuvant therapy protocols to enhance oncologic outcomes.

Objective: The aim of this study is to analyse the impact of surgical margins on survival outcomes for patients with oral cavity squamous cell carcinoma (OCSCC).

Methods: Pooled hazard ratios (HRs) and 95% confidence interval (CI) were calculated to define the impact of positive and close margins on overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS).

Results: A total of 14 studies enrolling 4839 patients (of whom 3837 males, or 79.3%), with a median age of 59 years, were included. The incidence of positive margins was 9.1%, while that of close margins was 27.3%. The estimated pooled HRs for patients with positive surgical margins were 2.265 (95% CI: 1.431-3.584; p = 0.003) for OS, 2.076 (95% CI: 1.652-2.608; p < 0.001) for DFS, and 2.163 (95% CI: 1.349-3.468; p = 0.014) for DSS. For patients with close margins, the HRs were 1.409 (95% CI: 1.064-1.866; p = 0.024) for OS, 1.775 (95% CI: 0.910-3.462; p = 0.078) for DFS, and 1.123 (95% CI: 0.425-2.974; p = 0.658) for DSS.

Conclusions: Positive surgical margins are a significant prognostic factor in OCSCC. Further studies are required to better define the impact of close margins.

Objective: Nasopharyngeal malignancies are rare heterogenous histologies (nasopharyngeal carcinoma [NPC], minor salivary glands carcinomas, and low-grade papillary nasopharyngeal adenocarcinoma) and a significant proportion of patients experience loco-regional recurrence after primary treatment. Resection margin status is a key prognostic factor that influences recurrence and survival, although definitions and criteria for negative, close, and positive margins remain inconsistent. This systematic review with meta-analysis aimed to summarise the existing definitions of resection margins in the literature and evaluate their impact on clinical outcomes in patients undergoing nasopharyngectomy with a specific focus on NPC.

Methods: A systematic literature review was conducted according to PRISMA guidelines. Electronic databases (Scopus, PubMed, and Web of Science) were searched up to November 2024. Studies reporting on surgical margins and survival outcomes in patients with NPC treated with endoscopic or open nasopharyngectomy were included. Pooled odds ratios (OR) for overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were calculated using a random-effects model.

Results: A total of 45 studies met the inclusion criteria, with 12 included in the meta-analysis. Positive surgical margins were associated with worse 5-year DFS (OR 2.21, 95% CI 1.55-3.14, p < 0.001), while no significant impact was observed on 3-year DFS (OR 2.3, p = 0.239), 3-year OS (OR 2, p = 0.167), 5-year OS (OR 2.98, p = 0.115), 3-year DSS (OR 1.25, p = 0.761), or 5-year DSS (OR 2.57, p = 0.265). Margin positivity rates were 16.9% for endoscopically-treated NPC, 20.6% for open-surgery NPC, and 20.6% for mixed histology, with no significant difference between surgical approaches (p = 0.995).

Conclusions: Positive resection margins significantly impact DFS in recurrent NPC. Standardised margin definitions are needed to improve prognostication and guide decisions on adjuvant therapy.

Objective: To evaluate the prognostic significance of surgical margins in patients undergoing transoral laser microsurgery (TLM) for laryngeal squamous cell carcinoma (LSCC).

Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Cochrane Library, Scopus, and Google Scholar following PRISMA guidelines. Studies comparing oncologic outcomes between positive and negative resection margins were included. Hazard ratios (HRs) for local control (LC), disease-free survival (DFS), and overall survival (OS) were extracted and pooled using a random-effects model to account for inter-study variability.

Results: A total of 26 studies, including 5,463 patients, met inclusion criteria. The pooled log-HR for DFS was 0.93 (p < 0.05), indicating a significantly higher risk of recurrence in patients with positive margins. However, no significant differences were observed for LC (log-HR = -0.76, p = 0.59) or OS (log-HR = 0.16, p = 0.40).

Conclusions: While positive surgical margins significantly impact DFS, their effect on LC and OS remains uncertain. Further prospective studies are necessary to refine treatment guidelines and optimise oncologic outcomes.