Management of Early Glottic Cancer Treated by CO2 Laser According to Surgical-Margin Status: A Systematic Review of the Literature

Abstract

Introduction Transoral laser microsurgery (TLM) is the treatment of choice for Tis-T2 squamous cell glottic carcinomas due to its advantages compared with open surgery and radiotherapy. However, the CO2 laser beam causes changes and damage on the specimens, making the histological assessment of resection margins, the gold standard for confirming radical tumor resection, sometimes difficult. Objective To assess the different ways to manage patients depending on the status of the histopathological margin according to recent studies to detect the most commonly shared therapeutic strategy. Data Synthesis We analyzed the literature available on the PubMed and Web of Science databases, including only articles published since 2005, using specific keywords to retrieve articles whose titles and abstracts were read and analyzed independently by two authors to detect relevant studies. Therefore, we focused on disease-free survival, overall survival, local control, laryngeal preservation, and disease-specific survival. Thus, 17 studies were included in the present review; they were grouped according to the status of the histological margin, and we analyzed the different management policies described in them. This analysis showed that there is not a shared strategy, though in most studies the authors performed a second-look surgery in the cases of positive margins and a close follow-up in cases of negative ones. The main disagreement is regarding the management of close or non-valuable resection margins, since some some authors performed a second-look surgery, and others, a close follow-up. Conclusions Definitely, the most shared policy is the second-look surgery in case of positive surgical margins, and a close follow-up in case of close or non-valuable resection margins. Key Points

Expression and clinical significance of FGFR1 and FGFR2 in laryngeal squamous cell carcinoma

“…Surgical resection remains the main basic treatment for laryngeal cancer, although according to its anatomical classification and lymph node metastasis, auxiliary radiotherapy and chemotherapy may also produce effective results. While the most significant effect was seen in early vocal cord carcinoma and glottic laryngeal carcinoma without lymph node metastasis using plasma cryogenic ablation and microscopic CO 2 laser cautery, compared with traditional laryngotomy, CO 2 laser burning is popular due to its characteristics of short operation time, reducing the damage of vocal cord tissue, reducing destruction of the laryngeal anatomical frame structure, and preserving laryngeal function ( 12 ). For advanced laryngeal cancer, the prognosis is poor, and exploring new diagnosis and treatment methods has become a boom of academic research in recent years.…”

Márgenes histopatológicos positivos: ¿se relacionan siempre con recidiva tumoral en carcinoma glótico temprano?

“…Por otro lado, el manejo intraoperatorio y posteriormente el análisis de los márgenes quirúrgicos debe ser meticuloso. El margen quirúrgico se clasifica como positivo, negativo o cercano (15). Sin embargo, existe un debate en la literatura médica respecto a la distancia ideal entre el margen y el tumor, y las recomendaciones para considerar el margen como negativo varían entre 0,5 a 2 mm (21-28).…”

“…Además, existen otros factores inherentes a la técnica quirúrgica y al procesamiento histopatológico de la muestra que afectan la lectura de los márgenes. Los más significativos son la contracción térmica de los tejidos por el calor del láser CO2, la carbonización del tejido que dificulta la valoración del margen del espécimen, y la manipulación durante el procesamiento de la muestra (15). Adicionalmente, se ha descrito que el láser de CO2 puede eliminar células tumorales al vaporizar el tejido de la laringe.…”

“…La MTL ha ganado terreno y se ha establecido como una opción efectiva para el manejo de tumores glóticos tempranos. Lo anterior se debe a que presenta tasas de efectividad equivalentes a la cirugía abierta y a la radioterapia, y tiene muchas ventajas en comparación con estas últimas, como son una menor morbilidad, menor tiempo de hospitalización y mayor preservación del órgano (14)(15)(16).…”

Swallowing Outcomes in Open Partial Horizontal Laryngectomy Type I and Endoscopic Supraglottic Laryngectomy: A Comparative Study

“…Due to this attitude, diagnosis is often late and so prognosis of supraglottic cancer is poor [2]. Currently, T1-T2 supraglottic tumors can be treated by different strategies: radiotherapy (RT), transoral laser microsurgery (TLM) or open supraglottic laryngectomy (OPHL type I) [3,4]. The main goals of the treatment are: oncological radicality and organ and function preservation, in terms of swallowing, speaking and breathing.…”