Resection Bed Margins following Laser Cordectomy

Abstract

Objective: 1) To evaluate our experience with transoral CO₂ laser microsurgery (TLM) in patients with early glottic cancer. 2) To evaluate the effect of positive additional biopsies taken from the resection bed on the outcome of patients.

Method: Retrospective study of patients with early glottic cancer who were treated by TLM, between January 2001 and December 2009 at Carmel Medical Center. Resection bed margins (RBM) using cold instruments were taken from all patients. Local control rate, overall survival, and organ preservation rate were compared between patients with positive vs negative RBM.

Results: Sixty-four (24 Tis; 23 T1a; 10 T1b; 7 T2) patients were included in the study. Mean follow-up was 50 months ± 34 (12-130). Overall local control rate (LCR) was 81%. Only 10/64 (15%) patients had local failure and were referred to radiotherapy, after which 3 underwent salvage laryngectomy. Twenty-nine patients had positive RBM, and 35 had negative margins. Patients with positive RBM had poorer LCR (59% vs 100%, P = .0001) and lower organ preservation rate (84% vs 100%, P = .09) compared to patients with negative margins. However, overall survival was not different between the 2 groups.

Conclusion: TLM is an effective treatment modality in early glottic cancer. Positive RBM may indicate a residual disease and hence a poorer outcome. We recommend that patients with positive RBM should be treated with re-resection or radiation and should have close follow-up.