Substantiality of surgical margins in laryngeal carcinoma surgery
Zeki Tolga Bilece1, Hasan Emre Koçak1, Sedat Rüzgar2, Yazgı Köy3, Şule Özsoy3, Mehmet Faruk Oktay2
1Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi Kulak Burun Boğaz Kliniği, İstanbul, Türkiye
2Bağcılar Eğitim ve Araştırma Hastanesi Kulak Burun Boğaz Kliniği, İstanbul, Türkiye
3Bağcılar Eğitim ve Araştırma Hastanesi Patoloji Kliniği, İstanbul, Türkiye
Keywords: Laryngectomy, larynx carcinoma, recurrence, surgical margins.
Abstract
OBJECTIVE: This study aims to investigate whether millimetric tumor distances to surgical margins have any association with recurrences in larynx cancers.
METHODS: The study was conducted between January 2009 and December 2015 at Bağcılar Training and Research Hospital, Ear, Nose and Throat Clinic and included 159 patients (156 males, 3 females; mean age 60.1±9.5 years; range, 38 to 87 years) who were followed-up regularly after total or partial laryngectomy. Eighty-three patients, who underwent cordectomy or salvage laryngectomy, who did not undergo any surgical procedures, or who did not attend the follow-up visits were excluded.
RESULTS: Mean duration of follow-up was 58±20.8 months (range, 36 to 85 months). Tumor involvement of surgical margins was identified in 14 patients (8.8%). Tumors were at a mean distance of 4.3±4.7 mm (range, 1 to 30 mm) to the surgical margins when those margins were reported to be clear. During follow-ups, 21 patients were diagnosed with recurrences. On comparison of the patient groups with or without recurrences, mean tumor distance to surgical margins in the recurrence group was 3.6±4.1 mm, whereas this value was 4.3±4.8 mm in the non-recurrence group. Surgical margins were positive in four patients in the recurrence group and in 10 patients in the non-recurrence group. There were no statistically significant differences between the two groups in terms of mean margins or surgical margins. Rates of recurrences were statistically significant in patients who underwent radiation therapy, who had invasion of thyroid and cricoid cartilages, who had extracapsular invasion in lymph nodes, who had perineural and lymphatic invasions, and in those with advanced stage tumor and node cancer. There were no statistically significant differences in terms of recurrence rates or tumor differentiation and metastasis stages in patients with epiglottis or vascular invasions.
CONCLUSION: Resection of tumor at millimetric distances to surgical margins or positive surgical margins in laryngeal cancer surgery were not detected to be associated with recurrences.