The significance of positive margins in hemilaryngectomy specimens.

Abstract

This clinicopathologic study was undertaken to determine the meaning of surgical margins "involved" with carcinoma. The fate of hemilaryngectomy patients whose specimens had this finding was comparared with that of patients who had "uninvolved" margins. A consecutive series of 111 hemilaryngectomies performed for previously untreated invasive epidermoid carcinoma was analyzed. Serial step sections in a longitudinal plane were available for re-examination and re-evaluation of the surgical margins in each case. Clinical follow-up on every patient was current through 1972. Thirty-nine patients had cancer involvement of a margin in the hemilaryngectomy specimen. None of these patients received any immediate therapy but were followed only. Seven of these patients (18 percent) subsequently developed a biopsy proven local recurrence. Four of the 72 patients (6 percent) with uninvolved margins developed a local recurrence. The site of the positive margin in the specimen was compared with the clinical site of recurrence. The seven local recurrences in patients with positive margins were treated with full course irradiation or total laryngectomy. All of these patients are alive and free of cancer or have died of other causes without evidence of cancer. Of the four local recurrences in patients with negative margins one died of cancer; two are living and well, and one died of other causes. This study provides evidence to support the conservative management of those hemilaryngectomy patients who have involved margins in the resection specimen. No immediate treatment is required. Careful follow-up is indicated with 18 percent chance of clinical recurrence. These biopsy proven recurrences can then be successfully treated with total laryngectomy or full course irradiation. Utilizing this approach none of the 39 patients with involved margins died of cancer in the 5 to 12-year follow-up period.

Discrepancies in frozen section mucosal margin tissue in laryngeal squamous cell carcinoma

“…This series evaluated the margins based on review of gross specimens and not by microscopic analysis. In the study by Bauer et al, 14 patients with involved hemilaryngectomy margins ran a risk of local recurrence three times greater than those with uninvolved margins. However, Bauer et al pointed out that there was not an increased adverse survival effect with positive margins.…”

Laryngectomy whole organ serial sections Histological Parameters Correlated with Recurrence Rate

“…Differential retraction and curling of the tissues at the margins can distort normal tissue relationships, thus exposing tumor cells at a surface that is not really a surgical margin. Such difficulties can explain the lack of correlation observed by some authors between recurrence rate and the tumor involvement of surgical margins (17).…”

The Utility of Second Look Microlaryngoscopy after Trans Oral Laser Resection of Laryngeal Cancer

“…On the contrary several authors have reported absence of tumor in as much as 30% of the excised specimens after definitive procedure (microlaryngoscopic or open partial laryngectomy) has been undertaken following diagnostic confirmation of malignancy. Further, Bauer et al [11] have followed up R1 resections after vertical partial laryngectomy to note recurrence in only 18% (7 of 39). This reflects the low grade histology and efficacy of minimum margins in the realms of 3-4 mm following open partial laryngectomy as well as the recent trend of transtumoral laser microresection in large tumors.…”