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Value and role of surgical margins in transoral laser microsurgery of the larynx, literature review and clinical considerations

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A Letter to the Editor to this article was published on 21 November 2023

Abstract

Purpose

There is no agreement on the most appropriate post-operative pathway for the management of positive margins after laser cordectomy for early stage glottic tumours (T1-2N0M0). This literature review and meta-analysis aim to evaluate the post-operative treatment with the best oncological results among follow-up, radiotherapy (RT) and surgical second look. The parameters utilized were incidence of recurrence, overall (OS), disease-specific (DSS) and disease-free (DFS) survival and larynx preservation (LP).

Methods

The articles were found through a string typed into PubMed from 2007 to 2022. The studies with detailed oncological results were selected according to inclusion criteria, and then the meta-analysis was carried out.

Results

Sixteen studies met the inclusion criteria for 2808 patients. The positive margin was found in 748 patients (26.6%), of which 416 were referred to follow-up, 89 to RT and 242 to a surgical second look. A false positive margin was found in 58/104 patients (56%). The recurrence rate in patients with positive margins was significantly higher (p = 0.003). In OS, DSS, DFS and LP, the odds ratio (OR) value was always greater than 1, assessing the role of the positive margin as a risk factor.

Conclusions

Prospective studies will be necessary to establish the role of positive margin as a prognostic factor. A surgical second look in case of positive margin seems to be the best option for the patient in terms of lower risk of recurrence and better oncological results. Better collaboration between surgeon and pathologist would be desirable to limit the real and false positive margins.

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Data availability

Anonymized raw data are available on request to the corresponding author.

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Funding

The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grants, or other support was received.

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Authors and Affiliations

  1. Department of Otolaryngology and Otoneurosurgery, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy

    M. Reale, M. L. Bardon, G. Ciavarro & G. P. Santoro

  2. Department of Medicine and Surgery, University of Parma, Parma, Italy

    G. Pedrazzi

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Contributions

GPS and MR had the idea for the article. MR, MLB and GPS performed the literature search. GP and GC performed data analysis. MR and MLB wrote the manuscript. MLB drawn Figure 4. GPS and GC critically revised the work.

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Correspondence to M. L. Bardon.

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Reale, M., Bardon, M.L., Ciavarro, G. et al. Value and role of surgical margins in transoral laser microsurgery of the larynx, literature review and clinical considerations. Eur Arch Otorhinolaryngol 281, 23–30 (2024). https://doi.org/10.1007/s00405-023-08238-9

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