Transtumoral approach and piecemeal resection (Steiner principle) for the treatment of tongue cancer at stage T1-T2: A pilot study.

Abstract

Background: To assess the feasibility of maximizing negative margins with minimal resection of healthy tissue, as confirmed by intraoperative assessment. This approach aims to be safe, effective, and to be considered a standard procedure.

Material and methods: A prospective pilot study. Peritumoral ink marking aided in identifying margins. Transtumoral incisions were made along the central line until healthy tissue was visible. If positive or close margins were identified, an extension was performed only in the involved area. The tumor bed and outer part of the tumor were inked to determine margins for intraoperative assessment of the specimen.

Results: Twelve patients with oral squamous cell carcinoma participated in the study, comprising 3 men and 9 women, with a mean age of 58 years. Four patients were diagnosed with clinical stage I (T1N0), while eight were classified as stage II (T2 N0). All patients underwent ipsilateral neck dissection (levels I-III). Intraoperative outcomes included negative, positive, or close margins. The number of tissue blocks varied based on the size of the tongue tumor and the segments that required expansion to ensure a tumor-free margin (>1 mm), which was necessary in 8 patients. All final pathological reports indicated negative margins of >1 mm.

Conclusions: Piecemeal resection emerges as a feasible and oncologically sound procedure for achieving margins >1mm, which are deemed safe. Precisely identifying positive areas within the tumor proves significantly safer than en bloc resections. The prognoses observed in this series depended more on regional disease factors than on specific characteristics of the primary tumor.