Clinical significance of intraoperative surgical margin study in supracricoid laryngectomy

Abstract

Objective: Supracricoid laryngectomy (SCL) is a reliable procedure for laryngeal preservation. However, due to the limited anatomy of the larynx, close surgical margins are often inevitable. Although the usefulness of intraoperative margin study on frozen section has been well documented in laryngeal surgery, the clinical significance of margin study in SCL has not been clarified. This study evaluated the evidence base supporting margin study in SCL.

Methods: Between 1997 and 2009, 61 patients underwent SCL. Margin study was conducted by histopathologically examining surrounding mucosal strips between the resected laryngeal specimen and the residual larynx using frozen sections. The findings were analyzed in terms of pT staging and prognoses.

Results: Among all patients, pathological report indicated all negative in 36, dysplasia in 18, and positive findings in seven patients. Positive results were exclusively identified at the ipsilateral posterior and inferior margins. The incidence of local recurrence and death due to disease was slightly higher in patients with positive reports. The margin study influenced the intraoperative decision to convert from SCL to total laryngectomy in one case.

Conclusions: In reviewing the margin study of 61 SCL patients, 11% resulted in positive margin. All except one patient with positive margin attained negative finding with additional samplings. Decision making regarding the resection margin can be difficult in patients with pT3-pT4 stages and postradiation status. Because of the exclusive identification of positive margin at the ipsilateral posterior and inferior edges, the margin study is strongly recommended at these sites. The possibility of converting SCL to TL should be discussed preoperatively during the informed consent process. The margin study is an effective modality for ensuring the validity of SCL and is recommended for all SCL procedures.