Assessment of Surgeon Judgment during Resection of Laryngeal Carcinoma

Document Type : Original

Authors

1 Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

2 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Carbon dioxide (CO2) laser surgery as a conservative tool plays a peculiar role in the management of head and neck cancer. Numerous patients who were candidates for transoral laryngeal microsurgery have forced us to eliminate frozen-section evaluation of surgical margins and use a magnified view of the larynx. The present study evaluated surgeon-judged negative margins with permanent microscopic pathologic evaluation.
 
Materials and Methods:
In this cross-sectional study, we evaluated the permanent pathologic margins of the resected laryngeal specimen which were considered negative by judgment of surgeons. Patients consisted of 61 pathologic proven T1-T2 laryngeal squamous cell carcinoma (SCC) cases. In all patients, tumor resection was performed via a transoral route with CO2 laser, and no residual laryngeal tumor was observed according to judgment of the surgeon. The patients with positive margin (s) underwent another resection. Patients were followed up for 18 months for tumor recurrence.
 
Results:
The obtained results demonstrated that pathologic margins were reported in 6 patients, with the deep margin being the most common positive margin. During the 18-month follow-up, 8 cases of recurrence were detected.
 
Conclusion:
Judgment of the surgeon was in agreement with permanent pathologic evaluation in transoral laryngeal laser resection at the early stages of laryngeal SCC in most cases. Nevertheless, it is suggested that further direct studies be conducted to evaluate the frozen section on oncologic outcomes in transoral laser surgery for laryngeal cancer. 
 

Keywords

References

  1. Mafi N, Kadivar M, Hosseini N, Ahmadi S, Zare-Mirzaie A. Head and neck squamous cell carcinoma in Iranian patients and risk factors in young adults: a fifteen-year study. Asian Pacific Journal of Cancer Prevention. 2012;13(7):3373-8.
  2. Flint PW, Haughey BH, Niparko JK, Richardson MA, Lund VJ, Robbins KT, et al. Cummings Otolaryngology-Head and Neck Surgery E-Book: Head and Neck Surgery, 3-Volume Set: Elsevier Health Sciences; 2010.
  3. Chiesa-Estomba CM, González-García JA, Larruscain E, Calvo-Henríquez C, Mayo-Yáñez M, Sistiaga-Suarez JA. CO2 Transoral Laser Microsurgery in Benign, Premalignant and Malignant (Tis, T1, T2) Lesion of the Glottis. A Literature Review. Medicines. 2019;6(3):77.
  4. Batra A, Goyal A, Goyal M, Goel S. Oncological Outcomes Following Transoral CO 2 Laser Microsurgery for T1 Glottic Cancer. Indian Journal of Otolaryngology and Head & Neck Surgery. 2018;1-6.
  5. Ambrosch P, Gonzalez-Donate M, Fazel A, Schmalz C, Hedderich J. Transoral laser Microsurgery for supraglottic cancer. Frontiers in oncology. 2018;8.
  6. Coskun H, Mendenhall WM, Rinaldo A, Rodrigo JP, Suárez C, Strojan P, et al. Prognosis of subglottic carcinoma: Is it really worse? Head & neck. 2019;41(2):511-21.
  7. Tjoa T, Armstrong WB. Transoral Laser Microsurgery for Laryngeal Cancer. Biomedical Optics in Otorhinolaryngology: Springer; 2016; p. 51-66.
  8. Fang TJ, Courey MS, Liao CT, Yen TC, Li HY. Frozen margin analysis as a prognosis predictor in early glottic cancer by laser cordectomy. The Laryngoscope. 2013;123(6):1490-5.
  9. Wong R, De Zoysa N, Fu B, Maskell S, Harries M. The significance of clinical margins in CO 2 laser resected laryngeal squamous cell carcinoma and its impact on disease management: Our experience in twenty‐nine patients. Clinical Otolaryngology. 2013;38(6):545-9.
  10. Hendriksma M, Montagne MW, Langeveld TPM, Veselic M, van Benthem PPG, Sjögren EV. Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO(2) laser microsurgery, on local control. Eur Arch Otorhinolaryngol. 2018;275(9):2333-40.
  11. Blanch JL, Vilaseca I, Bernal-Sprekelsen M, Grau J, Moragas M, Traserra-Coderch J, et al. Prognostic significance of surgical margins in transoral CO2 laser microsurgery for T1–T4 pharyngo-laryngeal cancers. European archives of oto-rhino-laryngology. 2007;264(9):1045-51.
  12. Piazza C, Paderno A, Grazioli P, Del Bon F, Montalto N, Perotti P, et al. Laryngeal exposure and margin status in glottic cancer treated by transoral laser microsurgery. The Laryngoscope. 2018;128(5):1146-51.

 

 

Iranian Journal of Otorhinolaryngology
Volume 32, Issue 4
July and August 2020
Pages 223-227

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