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. 2018 Sep;275(9):2333-2340.
doi: 10.1007/s00405-018-5070-9. Epub 2018 Jul 19.

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

Martine Hendriksma  1 , Marc W Montagne  2 , Ton P M Langeveld  2 , Maud Veselic  3 , Peter Paul G van Benthem  2 , Elisabeth V Sjögren  2
Affiliations

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

Martine Hendriksma et al. Eur Arch Otorhinolaryngol. 2018 Sep.

Abstract

Purpose: To 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.

Methods: Patients 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.

Results: Eighty-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.

Conclusions: Additional 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.

Keywords: Early glottic cancer; Laser surgery; Local control; Surgical margins; Wound bed biopsy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram
Fig. 2
Fig. 2
Kaplan–Meier curve for local control in relation to wound bed biopsies
See this image and copyright information in PMC

Comment in

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