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
-
To date, TLM is the treatment of choice for Tis-T2 squamous cell glottic carcinomas.
-
The CO2 laser beam could impair the histological assessment of the resection margins, which
is the gold standard to confirm radical tumor resection.
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Second-look TLM is the most performed strategy in case of positive surgical margins.
-
Close follow-up is the most shared policy in case of close or non-valuable resection
margins.
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In cases of negative resection margins, follow-up represents the best approach.
Keywords
glottic cancer - squamous cell carcinoma - laser surgery - surgical margin - second-look
surgery
