Background Achieving histologically clear margins is a cornerstone of curative surgery in oral squamous cell carcinoma (OSCC). However, tissue shrinkage from surgical excision, fixation, and histological processing can cause significant discrepancies between intraoperative and final pathological margins, potentially leading to overtreatment and misinterpretation of surgical adequacy. Aims and Objectives This study aimed to evaluate and analyze tumor margin shrinkage across sequential stages of surgical resection and histopathological processing in OSCC. • Primary Objective: To quantify margin shrinkage at four stages—preoperative in vivo planning, immediately post-resection (fresh specimen), after 24–48 h of formalin fixation, and on final histopathology. • Secondary Objectives: To compare shrinkage across anatomical subsites; to correlate shrinkage with pathological factors such as T-stage, depth of invasion (DOI), histological grade, perineural invasion (PNI), and lymphovascular invasion (LVI); to assess its impact on final margin classification (clear, close, positive) and implications for adjuvant therapy; and to identify clinicopathologic predictors of shrinkage using multivariate analyses. Methods We prospectively analyzed 45 patients undergoing curative OSCC resections at a tertiary cancer centre between March 2024 and February 2025. Margins were measured at four sequential stages: preoperative in vivo planning, immediately post-resection (fresh specimen), after 24 and 48 h of formalin fixation, and on final histopathology. Shrinkage was quantified as absolute (mm) and relative (%) reduction. Subsite-wise analyses were performed, and associations with pathological variables were assessed. Results Mean overall margin shrinkage was 4.3 mm (25.7%). The greatest contraction occurred immediately post-resection (~ 15–20%). Subsite analysis showed highest absolute shrinkage in the tongue (4.6 mm) and highest relative shrinkage in buccal mucosa and lower alveolus (~ 26–28%). Advanced T-stage, high grade, PNI, LVI, and deeper DOI correlated with increased shrinkage on univariate analysis, but multivariate regression revealed no single dominant predictor. Shrinkage reclassified several margins from “clear” intraoperatively to “close” or “positive” on pathology, with potential implications for adjuvant therapy. Conclusion Margin shrinkage in OSCC is substantial, predominantly occurs immediately after resection, and varies by subsite. Surgeons should anticipate this by aiming for wider intraoperative margins, particularly in high-shrinkage subsites such as buccal mucosa and alveolus. Recognizing shrinkage effects may prevent unnecessary adjuvant therapy and should be incorporated into surgical planning, pathology reporting, and guideline refinement. Graphical Abstract <Emphasis Type="BoldItalic">Comprehensive graphical summary</Emphasis> ,illustrating the global epidemiology of oral squamous cell carcinoma (OSCC), key risk factors, surgical margin definitions, mechanisms and phases of margin shrinkage, subsite-specific variability, and the resulting clinical and medico-legal implications. This visual highlights the need for a subsite- and time-dependent approach to margin planning and assessment, forming the rationale for the present study

From Scalpel to Slide: The Enigma of Tumor Margin Shrinkage in Oral Cancer Resection

期刊论文
发表日期：

2026年6月22日

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Saurin Chaudhary,
Kumar Vinchurkar,
Adarsh Sanikop,
Preeti Maste,
Ahuti Pandya,
Praveen Kumbar,
Jyoti Mane

摘要

Background

Achieving histologically clear margins is a cornerstone of curative surgery in oral squamous cell carcinoma (OSCC). However, tissue shrinkage from surgical excision, fixation, and histological processing can cause significant discrepancies between intraoperative and final pathological margins, potentially leading to overtreatment and misinterpretation of surgical adequacy.

Aims and Objectives

This study aimed to evaluate and analyze tumor margin shrinkage across sequential stages of surgical resection and histopathological processing in OSCC.

• Primary Objective: To quantify margin shrinkage at four stages—preoperative in vivo planning, immediately post-resection (fresh specimen), after 24–48 h of formalin fixation, and on final histopathology.

• Secondary Objectives: To compare shrinkage across anatomical subsites; to correlate shrinkage with pathological factors such as T-stage, depth of invasion (DOI), histological grade, perineural invasion (PNI), and lymphovascular invasion (LVI); to assess its impact on final margin classification (clear, close, positive) and implications for adjuvant therapy; and to identify clinicopathologic predictors of shrinkage using multivariate analyses.

Methods

We prospectively analyzed 45 patients undergoing curative OSCC resections at a tertiary cancer centre between March 2024 and February 2025. Margins were measured at four sequential stages: preoperative in vivo planning, immediately post-resection (fresh specimen), after 24 and 48 h of formalin fixation, and on final histopathology. Shrinkage was quantified as absolute (mm) and relative (%) reduction. Subsite-wise analyses were performed, and associations with pathological variables were assessed.

Results

Mean overall margin shrinkage was 4.3 mm (25.7%). The greatest contraction occurred immediately post-resection (~ 15–20%). Subsite analysis showed highest absolute shrinkage in the tongue (4.6 mm) and highest relative shrinkage in buccal mucosa and lower alveolus (~ 26–28%). Advanced T-stage, high grade, PNI, LVI, and deeper DOI correlated with increased shrinkage on univariate analysis, but multivariate regression revealed no single dominant predictor. Shrinkage reclassified several margins from “clear” intraoperatively to “close” or “positive” on pathology, with potential implications for adjuvant therapy.

Conclusion

Margin shrinkage in OSCC is substantial, predominantly occurs immediately after resection, and varies by subsite. Surgeons should anticipate this by aiming for wider intraoperative margins, particularly in high-shrinkage subsites such as buccal mucosa and alveolus. Recognizing shrinkage effects may prevent unnecessary adjuvant therapy and should be incorporated into surgical planning, pathology reporting, and guideline refinement.

Graphical Abstract

Comprehensive graphical summary ,illustrating the global epidemiology of oral squamous cell carcinoma (OSCC), key risk factors, surgical margin definitions, mechanisms and phases of margin shrinkage, subsite-specific variability, and the resulting clinical and medico-legal implications. This visual highlights the need for a subsite- and time-dependent approach to margin planning and assessment, forming the rationale for the present study