The Utility of Frozen Section Margin Analysis in Transoral Robotic Surgery

Abstract

Objective: Determine the benefit of frozen section margin analysis on oncologic specimens resected via Transoral Robotic Surgery (TORS).

Method: A retrospective, single institution chart review of 150 consecutive patients with upper aerodigestive tract malignancies who underwent Transoral Robotic Surgery with intraoperative frozen section margin analysis between April 2007 and November 2010.

Results: A total of 105 of the 150 cases were found to have negative tumor margins on initial tumor extripation. None of these patients were found to have delayed positive margins on permanent section analysis. Forty-five patients were found to have 1 or more positive margins on frozen section analysis following initial tumor, and/or tumor margin resection. These positive margins were all re-resected until frozen section pathology was consistent with tumor free margins (no evidence of CIS or invasive carcinoma). Of the 45 patients who underwent re-resection of initial tumor involved margins, 2 were found to have positive margin disease on permanent section pathology.

Conclusion: Frozen section margin analysis is a critical intraoperative tool in Transoral Robotic Surgery that accurately accesses margin free tumor resection. This technique allows for a single operative encounter consisting of initial tumor biopsy with rapid diagnosis, followed by immediate complete primary tumor resection with synchronous neck dissection when oncologically indicated.