Assessment and interpretation of the status of surgical margins following resective surgery for head and neck squamous cancer: a narrative review

Background: The two well-known quality-assessment metrics of head and neck oncosurgery are the status of surgical margin (SM) and lymph node yield (LNY). While the clinical importance of LNY has been well-established, several unresolved controversies around the SM have deterred its practical application. Methods: This article reviews some of the issues with the SM and ongoing efforts to improve its clinical application and reliability. Results: Several variations exist around SM, regarding its definition, designation, procurement, handling, and pathological processing, which could hinder its reliability. Until newer instruments that could improve the safety of surgical resection are validated robustly and are accessible widely, the surgeons need to adhere to the standardized approach of using the SM in clinical practice. Conclusions: Unless not available, the SM based on the surgical specimen should be given priority for all practical purposes over the tissue taken from the surgical bed; with the latter serving only as an intraoperative guide, to facilitate an appropriate margin revision whenever needed and feasible.