[Evaluation of resection margins as a prognostic factor in the surgical treatment of laryngeal carcinoma]. / Il valore prognostico della valutazione dei margini di resezione nel trattamento chirurgico del carcinoma laringeo.

ABSTRACT

A series of 564 patients who underwent conservative or radical surgery for laryngeal carcinoma were studied in a postoperative follow-up. In particular the onset of local recurrences was studied in relation to the histopathological typing of the resection margin. Histology was performed both on the surgical sample and performing an additional biopsy on the surgical margin. The incidence of local recurrences--in relation to the positive or negative tumor infiltration at the resection margins of the surgical sample--was analogous throughout the entire case study (11.1% vs. 11.7%). Only as light increase in the incidence of recurrence was found in those patients with partial laryngectomy (12% vs. 8.9%) although this was not statistically significant. On the contrary, when the marginal biopsy tested positive for neoplasm, it was clearly and significantly related to a higher incidence of T recurrences. This held true for all cases as a whole (36.4% vs. 10.1%, p < 0.04) and, in particular for those treated with partial laryngectomy (46.2% vs. 3%, p < 0.02). On the basis of these observations it can be concluded that, where possible, additional biopsy should be performed to integrate the traditional evaluation of the margins of the surgical piece in order to gain greater prognostic reliability, particularly in cases of partial surgery. From the therapeutic point of view, the authors assert that scheduling supplementary radiation therapy and shorter intervals between follow-up examinations is timely if the resection margin tests positive.