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Scientific Oral Presentation

Head and Neck Surgery

Does Intraoperative Re-resection in Oral Squamous Cell Carcinoma Improve Outcomes? A Systematic Review and Meta-analysis

Monday, October 19, 2026
1:00 PM - 1:06 PM PT
Location: West Exhibit Hall A, Learning Zone 3

    Presenting Author(s)

  • John J. Caraway, MD

    Resident
    Walter Reed National Military Medical Center
    Bethesda, Maryland, United States

    • Co-Author(s)

  • TW

    Taylor Wrozek, BS

    Medical Student
    USUHS, United States

  • SG

    Sean Garin, BS

    Medical Student
    USUHS, United States

  • AY

    Alex Yang, MD

    Otolaryngology Resident
    Walter Reed National Military Medical Center, United States

    • Senior Author(s)

  • Michael Ian Orestes, MD

    Staff Laryngologist
    Walter Reed National Military Medical Center
    Bethesda, Maryland, United States

Introduction: Intraoperative frozen margin analysis is widely utilized during oral cavity squamous cell carcinoma (OCSCC) excision to identify positive margins and guide re-resection. However, emerging evidence demonstrates that patients requiring intraoperative re-resection have significantly worse outcomes compared to those with negative margins on initial resection, suggesting positive margins reflect biologically aggressive tumor behavior rather than technical surgical error. This study presents the first meta-analysis examining recurrence and survival outcomes in OCSCC patients requiring intraoperative re-resection versus those achieving clear margins initially.

Methods: A comprehensive literature search was conducted using PubMed, Embase, and Web of Science. Studies met inclusion criteria if they conducted intraoperative margin analysis in patients with OCSCC and reported recurrence and/or survival outcomes for the following cohorts: clear margins on initial resection and final pathology (R0/R0), positive margins re-resected to negative margins on final pathology (R1/R0), and positive margins on final pathology (R1). Random effects meta-analyses were used to analyze the compiled data. Authors strictly adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) strategy.

Results: The literature search returned 4665 articles, of which 15 (3204 participants) met criteria for inclusion and meta-analysis. The R1/R0 cohort had significantly higher overall recurrence rates and worse overall survival compared to the R0/R0 group (P < 0.005). Notably, no significant differences in recurrence or survival outcomes were found between the R1/R0 and R1 groups (P > 0.005).

Conclusions: OCSCC patients requiring intraoperative re-resection have significantly worse recurrence and survival outcomes compared to those with clear margins on initial resection. Ultimately, achieving negative margins via re-resection offers no survival benefit.