PMID- 35687939
OWN - NLM
STAT- MEDLINE
DCOM- 20220920
LR  - 20220920
IS  - 1532-818X (Electronic)
IS  - 0196-0709 (Linking)
VI  - 43
IP  - 5
DP  - 2022 Sep-Oct
TI  - National analysis of positive surgical margins in oropharyngeal salivary gland 
      malignancies.
PG  - 103527
LID - S0196-0709(22)00154-5 [pii]
LID - 10.1016/j.amjoto.2022.103527 [doi]
AB  - OBJECTIVE: Positive surgical margins (PSM) are associated with worse survival in 
      oropharyngeal salivary gland malignancies (OPSGM), but existing literature is 
      limited to small series. Our objective was to identify risk factors for PSM using 
      the national cancer database (NCDB), including a transoral robotic surgical 
      (TORS) approach. METHODS: NCDB was queried for patients with T1-T4a OPSGM 
      undergoing resection between 2010 and 2017. Risk factors for PSM were determined 
      using logistic regression. Overall survival (OS) was analyzed using Kaplan-Meier 
      and Cox proportional hazards models. RESULTS: Of 785 patients, 165 (21.0 %) had 
      PSM. Age, stage T4a tumors (OR 2.00, 95 % Confidence Interval [CI]: 1.03-3.88), 
      adenoid cystic carcinoma (OR 2.02, 95 % CI: 1.29-3.18), and treatment at lower 
      volume institutions (OR 1.68, 95 % CI: 1.09-2.59) were all independently 
      associated with PSM. TORS versus a non-robotic approach was not associated with 
      PSM (23.9 % vs 20.4 %, p 0.358), respectively. Positive margins were 
      independently associated with a worse OS than negative margins (HR 1.63, 95 % CI: 
      1.03-2.59). Adjuvant radiation therapy was associated with improved survival in 
      high grade tumors with positive margins. CONCLUSION: This study represents the 
      largest review assessing risk factors for positive margins in OPSGM. Histologic 
      type (adenoid cystic carcinoma), age, T4a tumor stage and treatment at a lower 
      volume institution were all predictive of positive margins. With increasing use 
      of TORS over the last decade, there does not appear to be a greater risk of 
      positive margins using this modality in select patients. LEVEL OF EVIDENCE: N/A.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Llerena, Pablo
AU  - Llerena P
AD  - Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
FAU - Wang, Kevin
AU  - Wang K
AD  - Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
FAU - Puram, Sidharth V
AU  - Puram SV
AD  - Dept. of Otolaryngology-Head and Neck Surgery, Washington University School of 
      Medicine, St. Louis, MO, USA; Dept. of Genetics, Washington University School of 
      Medicine, St. Louis, MO, USA.
FAU - Pipkorn, Patrik J
AU  - Pipkorn PJ
AD  - Dept. of Otolaryngology-Head and Neck Surgery, Washington University School of 
      Medicine, St. Louis, MO, USA.
FAU - Jackson, Ryan S
AU  - Jackson RS
AD  - Dept. of Otolaryngology-Head and Neck Surgery, Washington University School of 
      Medicine, St. Louis, MO, USA.
FAU - Bollig, Craig A
AU  - Bollig CA
AD  - Dept. of Otolaryngology- Head and Neck Surgery, Rutgers Robert Wood Johnson 
      Medical School, New Brunswick, NJ, USA. Electronic address: cbollig7@gmail.com.
LA  - eng
PT  - Journal Article
DEP - 20220602
PL  - United States
TA  - Am J Otolaryngol
JT  - American journal of otolaryngology
JID - 8000029
SB  - IM
MH  - *Carcinoma, Adenoid Cystic/pathology
MH  - Child, Preschool
MH  - Humans
MH  - Margins of Excision
MH  - Neoplasm Staging
MH  - *Oropharyngeal Neoplasms/surgery
MH  - Retrospective Studies
MH  - *Robotic Surgical Procedures
MH  - *Salivary Gland Neoplasms/pathology
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Minor salivary glands
OT  - Oropharynx
OT  - Positive surgical margins
OT  - Salivary gland cancer
OT  - Transoral robotic surgery (TORS)
COIS- Declaration of competing interest There are no conflicts of interest or financial 
      disclosures.
EDAT- 2022/06/11 06:00
MHDA- 2022/09/21 06:00
CRDT- 2022/06/10 18:14
PHST- 2022/04/18 00:00 [received]
PHST- 2022/05/30 00:00 [revised]
PHST- 2022/05/30 00:00 [accepted]
PHST- 2022/06/11 06:00 [pubmed]
PHST- 2022/09/21 06:00 [medline]
PHST- 2022/06/10 18:14 [entrez]
AID - S0196-0709(22)00154-5 [pii]
AID - 10.1016/j.amjoto.2022.103527 [doi]
PST - ppublish
SO  - Am J Otolaryngol. 2022 Sep-Oct;43(5):103527. doi: 10.1016/j.amjoto.2022.103527. 
      Epub 2022 Jun 2.