Intraoperative specimen-driven assessment of resection margins as frozen section diagnosis and videoconference-based evaluation in head and neck carcinomas

Introduction Resection status has high prognostic and therapeutic relevance in the treatment of head and neck carcinomas. For the evaluation of the R-status, the assessment of resection margins on the intact resection specimen shows the best reliability. If this method is performed intraoperatively as frozen section diagnosis, it is associated with a higher time and personnel expenditure and is therefore only used in a few clinics.

Methods Feasibility study of intraoperative specimen-driven assessment of resection margins as frozen section diagnosis with videoconference-based evaluation. Included were en bloc resectable squamous cell carcinomas of the oral cavity and oropharynx. After workup of the specimen by the consultant pathologist, a videoconference was performed with demonstration of the critical regions on the previously oriented specimen so that targeted re-resection could be performed.

Results Between 05/2022 and 10/2022, intraoperative specimen-driven assessment of resection margins was applied in 12 patients. A secure R0 status was obtained in 6 cases, and an R0 status with close margin situation was obtained in 6 cases. Precise videoconference-based correlation of the close margins allowed targeted re-resection in each case, which then resulted in a clear margin situation. In no case did further reprocessing of the specimen result in a change in R status.

Conclusions Intraoperative specimen-driven assessment of resection margins appears to be an optimal tool to determine the true R-status with increased, yet defined, time and personnel requirements.

Publication History

Article published online:
12 May 2023