Prognostic value of the status of resection margins after endoscopic laser cordectomy for T1a glottic carcinoma

Michel, J.; Fakhry, Nicolas; Duflo, S.; Lagier, Aude; Mancini, Julien; Dessi, P.; Giovanni, Antoine

doi:10.1016/j.anorl.2011.05.006

Cited by 41 publications

(62 citation statements)

References 20 publications

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“…Furthermore, we cannot exclude a local variation in evaluation protocol having led to this result, and finally we cannot exclude that the pathologist reviewing the samples may have been the particularly meticulous knowing that the results would be analysed for a study. Despite the high rate of positive margins, our data are in line with the literature, showing that positive margins have no impact on local control [8, 10, 11, 16]. …”

Section: Discussionsupporting

confidence: 91%

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Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control

Hendriksma

Montagne

Langeveld

et al. 2018

Eur Arch Otorhinolaryngol

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PurposeTo assess the impact of surgical margins status on local control in patients with primary early glottic (Tis-T2) squamous cell carcinoma after treatment with transoral CO2 laser microsurgery (TLM) and to assess the significance of additional wound bed biopsies.MethodsPatients with Tis-T2 tumours treated with TLM type I–III resections according to the European Laryngological Society classification between 2009 and 2013 were included in retrospective analysis. Recurrence rate was determined in patients with free versus non-free specimen margins and wound biopsies. Five-year survival rates were determined using the Kaplan–Meier method. Prognostic impact of pT-category, resection margin status, tumour differentiation, wound bed biopsy status, and number of biopsies on local control (LC) were tested with the log-rank test.ResultsEighty-four patients were included in the analysis. Positive margins were seen in 68 patients (81.0%). Margin status after TLM did not significantly influence LC (p = 0.489), however, additional wound bed biopsies were significantly associated with lower LC (p = 0.009). Five-year LC, disease-specific survival, overall survival and laryngeal preservation were 78.6, 78.0, 98.6 and 100%, respectively.ConclusionsAdditional wound bed biopsies can help predict local recurrence in patients treated with TLM for early glottic carcinoma. We propose that there is enough evidence to support a wait-and-see policy in patients with positive specimen margins and negative wound bed biopsies. For patients with positive wound bed biopsies, further treatment is warranted.

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Section: Discussionsupporting

confidence: 91%

“…However, others conclude that positive margins have no influence on local control [8, 10, 11, 16]. Therefore, the best management of close or positive margins has not been clearly determined [13] although it has been shown that mandatory retreatment could lead to unnecessary additional treatment in up to 84% of these patients [11].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control

Hendriksma

Montagne

Langeveld

et al. 2018

Eur Arch Otorhinolaryngol

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“…The significance of positive or close margins has been the subject of several retrospective studies with conflicting results: some studies found a significant increase in local recurrence for patients with close or positive margins 32,33 whereas others were not able to show a significant difference. 4,[34][35][36] Deep positive margins, however, after the first TLM resection contributed to lower local control and organ preservation rates for Peretti and colleagues. 4 Thus, close superficial margins may undergo complementary resection with the laser or a close watch-and-wait follow-up.…”

Section: Resection Marginsmentioning

confidence: 99%

Contemporary Surgical Management of Early Glottic Cancer

Hartl

Brasnu

2015

Otolaryngologic Clinics of North America

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“…As shown in Table 3, four authors chose a complete wait and see policy [64–67]. Others preferred a wait and see attitude but performed several second-look procedures, on clinical indication [68–70] or using the site of the positive margins (deep versus superficial) to decide whether a patient should be re-excised or not [32]. Re-treatment with either TLM or radiotherapy was standard only for three authors [71–73], although not all patients were handled according to protocol, mainly because of patients’ preference.…”

Section: Factors Affecting Oncological Outcomes Of Tlmmentioning

confidence: 99%

Transoral Laser Microsurgery in Early Glottic Lesions

Sjögren

2017

Curr Otorhinolaryngol Rep

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Purpose of ReviewTo give an overview of the evolvement of transoral laser microsurgery (TLM) in the treatment of early glottic carcinoma and highlight the contribution of recent literature.Recent FindingsThe indications and limits of TLM have been well specified. Effects on swallowing have been well documented. Introduction of narrow-band imaging (NBI) and diffusion-weighted magnetic resonance has been shown of additional value for outcome. The first reports on transoral robotic surgery show that it may be of added value in the future.SummaryTLM for early glottic carcinoma (Tis–T2) has very good oncological outcomes with indications of higher larynx preservation in TLM than that in radiotherapy. The anterior commissure is a risk factor if involved in the cranio-caudal plane, and reduced vocal fold mobility is a risk factor when this is due to arytenoid involvement. The best voice results are achieved when the anterior commissure can be left intact along with part of the vocal fold muscle although even in larger resections, patient self-reported voice handicap is still limited.

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Prognostic value of the status of resection margins after endoscopic laser cordectomy for T1a glottic carcinoma

Abstract: The present results show that margins considered positive after laser resection do not significantly impact carcinologic course, while still requiring close surveillance. The most generally recommended attitude is control endoscopy with biopsy at 10 weeks.

Cited by 41 publications

References 20 publications

Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control

Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control

Contemporary Surgical Management of Early Glottic Cancer

Transoral Laser Microsurgery in Early Glottic Lesions

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