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Will the mininvasive approach challenge the old paradigms in oral cancer surgery?
- Source :
- European Archives of Oto-Rhino-Laryngology. 274:1279-1289
- Publication Year :
- 2016
- Publisher :
- Springer Science and Business Media LLC, 2016.
-
Abstract
- In the genome era, the achievement of a safe and complete resection of oral cancers remains a challenge for surgeons. Margin length at histopathological examination is still considered the main indicator of oncological radicality. However, this parameter is fraught by major limitations. Cancer aggressiveness, and in particular its ability to spread in the surrounding tissue, most probably influences loco-regional control and prognosis more than margin length. Unfortunately, no molecular markers are currently available to predict tumor aggressiveness pre-operatively. However, additional histopathological parameters, beside margin length, could be considered to better stratify oral tumors, including depth of invasion (DOI), perineural invasion or composite scores. Recent advances in laser technology have established a novel surgical trend toward a minimalist approach, named transoral laser microsurgery (TLM). TLM provides a local control rate comparable to the one achieved by larger resections if the margin appears disease free, independent from its length. In addition, the clinical availability of innovative optical technologies, such as narrow band imaging (NBI) or autofluorescence, allows more precise and tailored resections, not simply based on clinical observation and ruler measurement. This review will propose the possible implementation of novel procedures toward a mini-invasive surgical approach, providing a satisfactory control rate but significantly improving the quality of life of the patients compared to conventional surgery.
- Subjects :
- Quality of life
Diagnostic Imaging
Microsurgery
medicine.medical_specialty
Perineural invasion
Optical imaging
Oral squamous cell carcinoma
Shrinkage of specimens
Surgical margins
Transoral laser microsurgery
Mandible
Surgical margin
03 medical and health sciences
0302 clinical medicine
Margin (machine learning)
Preoperative Care
medicine
Shrinkage of specimen
Humans
Minimally Invasive Surgical Procedures
030223 otorhinolaryngology
Intraoperative Care
business.industry
Margins of Excision
Cancer
General Medicine
medicine.disease
Surgery
Otorhinolaryngology
030220 oncology & carcinogenesis
Carcinoma, Squamous Cell
Quality of Life
Mouth Neoplasms
Laser Therapy
Neurosurgery
business
Cancer surgery
Subjects
Details
- ISSN :
- 14344726 and 09374477
- Volume :
- 274
- Database :
- OpenAIRE
- Journal :
- European Archives of Oto-Rhino-Laryngology
- Accession number :
- edsair.doi.dedup.....cba8b84038c170200bf6ad4e01b9d1ea