Management and Oncologic Outcomes of Close and Positive Margins after Transoral CO2 Laser Microsurgery for Early Glottic Carcinoma

Abstract

Background: The present study analyzed the impact of margin status on local control and survival, and the management of close/positive margins after transoral CO2 laser microsurgery for early glottic carcinoma. Methods: 351 patients (328 males, 23 females, mean age 65.6 years) underwent surgery. We identified the following margin statuses: negative, close superficial (CS), close deep (CD), positive single superficial (SS), positive multiple superficial (MS), and positive deep (DEEP). Results: A total of 286 patients (81.5%) had negative margins, 23 (6.5%) had close margins (8 CS, 15 CD) and 42 (12%) had positive margins (16 SS, 9 MS, 17 DEEP). Among the 65 patients with close/positive margins, 44 patients underwent enlargement, 6 radiotherapy and 15 follow-up. Twenty-two patients (6.3%) recurred. Patients with DEEP or CD margins showed a higher risk of recurrence (hazard ratios of 2.863 and 2.537, respectively), compared to patients with negative margins. Local control with laser alone, overall laryngeal preservation and disease-specific survival decreased significantly in patients with DEEP margins (57.5%, 86.9% and 92.9%, p < 0.05). Conclusions: Patients with CS or SS margins could be safely submitted to follow-up. In the case of CD and MS margins, any additional treatment should be discussed with the patient. In the case of DEEP margin, additional treatment is always recommended.

The impact of undergoing surgical margin evaluation during endoscopic surgery for early‐stage laryngeal squamous cell carcinoma

“…These findings build upon previous literature evaluating the prognostic effect of margin positivity for early stage LSCC treated with endoscopic surgery. Previous studies have found rates of margin positivity for these tumors to be between 12.0% and 45.4%, 3–12 similar to the margin positivity rate of 23.6% in the present study. In addition, this study's findings of 68.2% 5‐year overall survival for patients with positive margins and 77.0% for patients with negative margins are similar to previous studies, which found overall survival to be between 67.1% and 89.0% for patients with positive margins and 82.9% and 96.8% for patients with negative margins 3,6,9 .…”

“…Achieving negative pathologic surgical margins is believed to be an important consideration to reduce both the necessity for additional treatments, such as adjuvant treatment and re‐operation, and the risk of recurrence 2 . For Stage I‐II glottic LSCC treated with transoral laser microsurgery, surgical margin positivity rates have been reported to be between 12.0% and 45.4% 3–12 …”

“…[3][4][5][6][7][8][9][10][11][12] Previous literature has conflicted on the prognostic impact of surgical margin positivity for early-stage LSCC. Several studies have reported that positive surgical margins are associated with higher rates of local recurrence, [3][4][5][6] mortality, 13 and disease progression, 13 lower rates of organ preservation 5,6 and local control, 5 and worse diseasespecific 5,8,14,15 and disease-free survival. [6][7][8]15 Others have Presented at American Head and Neck Society 11th International Conference on Head and Neck Cancer, July 11, 2023, Montreal, QC.…”

“…2 For Stage I-II glottic LSCC treated with transoral laser microsurgery, surgical margin positivity rates have been reported to be between 12.0% and 45.4%. [3][4][5][6][7][8][9][10][11][12] Previous literature has conflicted on the prognostic impact of surgical margin positivity for early-stage LSCC. Several studies have reported that positive surgical margins are associated with higher rates of local recurrence, [3][4][5][6] mortality, 13 and disease progression, 13 lower rates of organ preservation 5,6 and local control, 5 and worse diseasespecific 5,8,14,15 and disease-free survival.…”

“…Previous literature has conflicted on the prognostic impact of surgical margin positivity for early‐stage LSCC. Several studies have reported that positive surgical margins are associated with higher rates of local recurrence, 3–6 mortality, 13 and disease progression, 13 lower rates of organ preservation 5,6 and local control, 5 and worse disease‐specific 5,8,14,15 and disease‐free survival 6–8,15 . Others have suggested, however, that surgical margin status may not have an impact on local control, 10 recurrence, 14 mortality, 16 disease‐free survival, 10,17,18 disease‐specific survival, 16,18 or overall survival 6,7,9 .…”