Intraoperative Margin Assessment Methods in Oral Cavity Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

Objective: Currently, there is a lack of consensus regarding the superiority of specimen-based versus tumor bed-based intraoperative margin analysis in oral cavity squamous cell carcinoma (OCSCC). The purpose of this study is to perform the first meta-analysis examining intraoperative margin assessment methods in OCSCC with the goal of determining if there is a significant difference in patient outcomes between specimen-driven and tumor bed-driven margin analysis. Data Sources: A comprehensive search of the literature was performed using PubMed, Embase, and Web of Science. Review Methods: Studies met inclusion criteria if they conducted intraoperative specimen-driven and tumor bed-driven margin analysis in patients with OCSCC and reported patient outcomes. Random effects meta-analyses were used to analyze the compiled data. Results: The literature search returned 1988 articles for initial review of which 9 (1240 participants) met criteria for inclusion and meta-analysis. Meta-analysis revealed that a specimen-based approach is associated with higher intraoperative re-resection rate (P <.05), significantly lower final positive margin rate (P <.05), and decreased local recurrence when compared to the tumor bed-based approach (P <.05). However, there was no significant difference in overall recurrence when comparing intraoperative margin analysis methods (P >.05). Additionally, none of the included studies noted a significant difference in survival outcomes between tumor bed versus specimen-based methods. Conclusion: Specimen-based frozen margin analysis in OCSCC results in lower false negative rates and improved local control; however, there is no significant difference in overall recurrence or survival when comparing specimen-based vs tumor bed-based techniques.