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Presidential Address |

Surgical Margins in the Genomic Era The Hayes Martin Lecture, 2012

Gregory T. Wolf, MD
Arch Otolaryngol Head Neck Surg. 2012;138(11):1001-1013. doi:10.1001/2013.jamaoto.82.
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One of the highest honors of one's career is to be asked to address colleagues, mentors, and students who represent the world's leading health professionals dedicated to reducing the morbidity and mortality associated with head and neck cancer. Hayes Martin would certainly share this feeling of honor and humility in having a lecture given in his name on the occasion of the Eighth International Conference on Head and Neck Cancer. I am so very pleased to share with you some thoughts on the assessment, adequacy, and application of surgical resection margins in an era in which personalized surgery and molecular medicine will have a major impact on patient outcomes. My thoughts about surgical margins have evolved over nearly 40 years of performing surgical resections for cancer. A discussion of margins may seem somewhat mundane to many of you; however, I hope to provide a futuristic and somewhat theoretical view of how surgical margin issues will relate to the personalization of modern head and neck cancer treatment and how the biology of the tumor microenvironment may be instructive in the application of our surgical approaches. This is particularly relevant because of the rapid expansion of functional surgical approaches utilizing minimally invasive endoscopic resections and robotic techniques that may not achieve the same wide oncologic margins that have been emphasized historically.1,2 Proper selection of patients for such procedures is critical if we are to improve overall treatment results.

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Figure. Four permutations of high and low epithelial-to-mesenchymal (EMT) and high and low mesenchymal-to-epithelial transition (MET) characteristics in the stem cell compartment at the tumor invasive front can be defined by several molecular markers of EMT and MET that would define risk, aggressiveness of resection, and necessity for adjuvant therapy prior to or following surgery. These markers can be related to histologic patterns of invasion. XRT indicates chemoradiation therapy.




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