Management of positive resection margins following transoral laser microsurgery for glottic cancer

Abstract

Abstract Objectives The current literature provides limited guidance on the management of positive margins (PMs) following transoral laser microsurgery (TLM) for glottic squamous cell carcinoma (SCC). Long‐term data exploring the treatment of PMs with both initial observation and re‐resection are limited. Our objective was to determine the optimal treatment for PM patients following TLM for glottic SCC. Methods Clinical information on glottic SCC patients with PMs following treatment with TLM was prospectively collected at our institution from 2007 to 2018. We use a laryngeal template during the initial TLM where the area of resection is outlined for future reference. Data were compared with univariate analysis and survival plots were generated using the Kaplan–Meier method. Results A total of 29 patients with PMs were treated with either re‐resection (19 patients), close observation (6 patients), or adjuvant radiation alone (4 patients). Re‐resection patients had SCC or severe dysplasia on initial margin pathology and 23% with early‐stage disease had recurrence (T1–T2). Five (83%) patients who underwent close observation required re‐resection based on clinical suspicion of recurrence (confirmed on final pathology), which was significantly different from the re‐resection patients (p < .05). Close observation was therefore discontinued as a management of PMs. Four patients (21%) had no residual malignancy on re‐resection specimens. Deep margins only accounted for 17% of all PMs. Disease‐specific survival for all PM patients at 5 years was 82.4% (SE 9.6%, CI 53.4%–91.6%). Conclusions Our long‐term experience with treating early‐stage glottic SCC with TLM supports re‐resection as an appropriate management for cases of PMs. Level of Evidence 4.

Keywords

• early glottic cancer
• head and neck
• laryngology