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The impact of margins in laryngeal cancer patients treated with transoral laser microsurgery: a systematic review and meta-analysis

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Abstract

Purpose

In laryngeal squamous cell carcinoma (LSCC) treated with transoral laser microsurgery (TOLMS), the status of margins significantly affected local control. When a positive or close margin is present, there is no ubiquitous consensus regarding further treatments. The rationale of the present systematic review and meta-analysis is to investigate the survival impact of the status of the margins in patients affected by LSCC treated with TOLMS.

Data sources

PubMed, EMBASE, and Cochrane Library.

Methods

We performed a systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were: patients affected by LSCC, staged according to the American Joint Committee on Cancer Staging System and treated by TOLMS without any previous treatment; margins status (close, positive, negative) and the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of overall survival, disease-specific survival, and disease-free survival has to be reported.

Results

Nine studies were deemed eligible for the qualitative analysis, and 3 for the quantitative analysis to investigate the association between margin status and OS. The cumulative number of patients was 3130. The sample size ranged from 96 to 747 patients. The follow-up period ranged from 0 to 201 months. The meta-analysis results show that positive margins have an aHR of 1.30 yet with CI range (0.56 to 2.97).

Conclusions

Our current meta-analysis results are unable to definitively assess the real impact of resection margins on OS. Few authors provide accurate data regarding position and types of margins. Further prospective or high-quality studies are required.

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Data availability

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.

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Author notes

  1. Andrea Iandelli and Giulia Gabella have contributed equally to this work.

  2. Filippo Marchi and Valentina Campagnari have contributed equally to this work.

Authors and Affiliations

  1. Otorhinlaryngology and Head and Neck Surgery Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy

    Andrea Iandelli, Giulia Gabella, Filippo Marchi, Valentina Campagnari, Marta Filauro, Claudio Sampieri & Giorgio Peretti

  2. Department of Surgical Science (DISC), University of Genova, Genoa, Italy

    Giulia Gabella, Filippo Marchi, Valentina Campagnari, Claudio Sampieri & Giorgio Peretti

  3. Otolaryngology and Head and Neck Surgery Unit, Hospital Clinic, Barcellona, Spain

    Claudio Sampieri & Isabel Vilaseca

  4. Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy

    Claudio Sampieri

  5. Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taoyuan, Taiwan

    Tsung-You Tsai

  6. Head Neck Clínic, Agència de Gestió d’Ajuts Universitaris i de Recerca, Barcelona, Catalunya, Spain

    Isabel Vilaseca

  7. Faculty of Medicine, University of Barcelona, Barcelona, Spain

    Isabel Vilaseca

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No animal studies are presented in this manuscript. Among the nine articles included in the meta-analysis, six have obtained approval from the respective ethics committees, while the remaining three do not report this data. No potentially identifiable human images or data are presented in this study.

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Among the nine studies included in the meta-analysis, three obtained informed consent from patients. Another three, due to the retrospective nature of the study, were exempt from requiring informed consent, in agreement with the ethics committee. The remaining three studies do not provide clarification on this matter.

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Iandelli, A., Gabella, G., Marchi, F. et al. The impact of margins in laryngeal cancer patients treated with transoral laser microsurgery: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol (2024). https://doi.org/10.1007/s00405-024-08610-3

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