Paradigm Change for Intraoperative Surgical Margin Assessment for Oral Squamous Cell Carcinoma

Objective Achieving clear surgical margins is one of the primary surgical goals in treating oral squamous cell carcinoma (OSCC) and thus aiming to improve overall and disease‐specific survival. Therefore, we developed the Goal‐Oriented Assessment for Intraoperative Margin (‘GAIM’) protocol, a novel intraoperative approach for margin assessment, and present here our 5‐year experience and outcomes. Methods ‘GAIM’ is a 7‐step procedure comprising systematic ruler‐aided resection of labeled tumor‐bed margins, frozen section (FS) co‐produced by both pathologists and operating surgeons, and immediate extension of resection according to FS findings. Data from all patients operated using the ‘GAIM’ protocol at a single tertiary center between 2018 to 2022 were analyzed, including margin status on FS and final pathology (FP) records, recurrence, and mortality. Results A total of 196 patients were included, 56.6% (n = 111) stages I‐II, and 43.4% (n = 85) stages III‐IV. Using the ‘GAIM’ protocol, we achieved an overall 94.4% of clean and revised clean surgical margins. Patients with a 2‐year and longer follow‐up (n = 141) had local recurrence in 3.5% when both FS and final margins were clean, 8.1% when FP margins were clean, and 16.7% with close/positive final margins. Conclusions The proposed ‘GAIM’ protocol is a novel, effective, reproducible, and safe approach for margin evaluation that can be systematically applied. It can increase the rate of final clean surgical margins and potentially improve patients' outcomes. Level of Evidence 3 Laryngoscope, 134:1725–1732, 2024 The study introduces the Goal‐Oriented Assessment for Intraoperative Margin (‘GAIM’) protocol, a 7‐step approach for margin assessment during surgery for oral squamous cell carcinoma (OSCC), which resulted in 94.4% of clean surgical margins and low local recurrence rates in patients with clear margins. The ‘GAIM’ protocol is a safe and effective method that can improve outcomes for OSCC patients.