Clinico-Pathological Profile and Surgical Margin Status in Patients Undergoing Wide Local Excision for Oral Squamous Cell Carcinoma

Abstract

Background: Oral squamous cell carcinoma (OSCC) is the most frequent cancer of the oral cavity. Its morbidity and mortality rate is high. The standard surgical treatment is the excision of the tumor with adequate margins. Opportune assessment of the surgical margins and the clinico-pathological characteristics of OSCC aids in the development of a treatment plan and estimation of prognosis.

Objective: The aim was to assess the clinico-pathological features and the status of surgical margins of patients who underwent wide local surgical excision for OSCC.

Methods: This cross-sectional study was carried out on 220 patients between ages 20 to 80 years old who had histopathological diagnosis of OSCC and had undergone wide local excision at a Swat Medial College Teaching Hospital Saidu Sharif Swat in the 12 months. Participants were selected using a non-probability sampling method. Using a pre-tested structured check list, the following were documented: age, sex, site of the tumor, size of the tumor, the TNM stage, histological grade, and status of the lymph nodes along with perineural and lymphovascular invasions. Also documented was the status of the surgical margin. This was categorized as clear (≥5 mm), close (1-4 mm), or involved (<1 mm). For analyses, version 26.0 of the SPSS software was utilized. Summarizing of data was done using descriptive statistics. Associations were evaluated using the chi-square test, with p<0.05 considered to be statistically significant. Results: The mean age of participants was 54.9 ± 12.3 years, and males made up 69.1% of the population. The most common site was buccal mucosa (42.3%), followed by tongue involvement (27.7%). The majority of the tumors were moderately differentiated (56.4%) and were of Stage III–IV (61.8%). Complete Surgical margins were obtained in 176 (80.0%) patients, while 31 (14.1%) had close margins, and in 13 (5.9%) patients, margins were involved. Advanced tumor stage, larger tumor size, poor histological differentiation, and lymph node metastasis had a significant statistical correlation with close/involved surgical margins (p< 0.05).

Conclusion: Though most patients with oral squamous cell carcinoma had advanced-stage disease, the majority had clear surgical margins after wide local excision. The adverse clinico-pathological features were significantly related to margin clearance, thereby showing the importance of early diagnosis and precise surgical margin planning for better results in patients.