Top

European Archives of Oto-Rhino-Laryngology

02-04-2024 | Laryngeal Cancer | Review Article

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

Authors: Andrea Iandelli, Giulia Gabella, Filippo Marchi, Valentina Campagnari, Marta Filauro, Claudio Sampieri, Tsung-You Tsai, Isabel Vilaseca, Giorgio Peretti

Published in: European Archives of Oto-Rhino-Laryngology

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.

Available only for authorised users

GBD (2019) Adolescent young adult cancer collaborators the global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Oncol 2022(23):27–52. https://doi.org/10.1016/S1470-2045(21)00581-7CrossRef

Peretti G, Piazza C, Del Bon F (2013) Function preservation using transoral laser surgery for T2–T3 glottic cancer: oncologic, vocal, and swallowing outcomes. Eur Arch Otorhinolaryngol 270:2275–2281. https://doi.org/10.1007/s00405-013-2461-9CrossRefPubMed

Peretti G, Piazza C, Penco S, Santori G, Del Bon F, Garofolo S, Paderno A, Guastini L, Nicolai P (2016) Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers. Head Neck 38:1107–1112. https://doi.org/10.1002/HEDCrossRefPubMed

Rodrigo JP, Garcia-Velasco F, Ambrosch P, Vander Poorten V, Suárez C, Coca-pelaz A, Strojan P, Hutcheson K, Folz BJ, Bernal-sprekelsen M et al (2019) Transoral laser microsurgery for glottic cancer in the elderly : efficacy and safety. Head Neck. https://doi.org/10.1002/hed.25616CrossRefPubMed

Meulemans J, Hauben E, Peeperkorn S, Nuyts S, Delaere P, Vander Poorten V (2020) Transoral laser microsurgery (TLM) for glottic cancer: prospective assessment of a new pathology workup protocol. Front Surg 7:56. https://doi.org/10.3389/fsurg.2020.00056CrossRefPubMedPubMedCentral

Piazza C, Filauro M, Paderno A, Marchi F, Perotti P, Morello R, Taboni S, Parrinello G, Incandela F, Iandelli A et al (2018) Three-dimensional map of isoprognostic zones in glottic cancer treated by transoral laser microsurgery as a unimodal treatment strategy. Front Oncol. https://doi.org/10.3389/fonc.2018.00175CrossRefPubMedPubMedCentral

Canis M, Ihler F, Martin A, Matthias C, Steiner W (2015) Transoral laser microsurgery for T1a glottic cancer: review of 404 cases. Head Neck 37:889–895. https://doi.org/10.1002/hed.23688CrossRefPubMed

Peretti G, Piazza C, Mora F, Garofolo S, Guastini L (2016) Reasonable limits for transoral laser microsurgery in laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 24:135–139. https://doi.org/10.1097/MOO.0000000000000240CrossRefPubMed

National Comprehensive Cancer Network. Head and Neck Cancers (Version 1.2022)

10.

Marchi F, Filauro M, Missale F, Parrinello G, Incandela F, Bacigalupo A, Vecchio S, Piazza C, Peretti G (2019) A multidisciplinary team guided approach to the management of CT3 laryngeal cancer: a retrospective analysis of 104 cases. Cancers. https://doi.org/10.3390/cancers11050717CrossRefPubMedPubMedCentral

11.

Vilaseca I, Bernal-sprekelsen M (2012) Transoral laser microsurgery for locally advanced laryngeal cancer. Acta Otorrinolaringol 64:140–149. https://doi.org/10.1016/j.otoeng.2013.04.009CrossRef

12.

Piazza C, Peretti G, Vander Poorten V (2018) Editorial: advances in transoral approaches for laryngeal cancer. Front Oncol 8:1–3. https://doi.org/10.3389/fonc.2018.00455CrossRef

13.

Blanch JL, Vilaseca I, Bernal-Sprekelsen M, Grau JJ, Moragas M, Traserra-Coderch J, Caballero M, Sabater F, Guilemany JM, Alos L (2007) Prognostic significance of surgical margins in transoral CO2 laser microsurgery for T1–T4 pharyngo-laryngeal cancers. Eur Arch Oto-Rhino-Laryngol 264:1045–1051. https://doi.org/10.1007/s00405-007-0320-2CrossRef

14.

Fiz I, Mazzola F, Fiz F, Marchi F, Filauro M, Paderno A, Parrinello G, Piazza C, Peretti G (2017) Impact of close and positive margins in transoral laser microsurgery for TIS-T2 glottic cancer. Front Oncol 7:245. https://doi.org/10.3389/fonc.2017.00245CrossRefPubMedPubMedCentral

15.

Marchi F, Piazza C, Ravanelli M, Gaggero G, Parrinello G, Paderno A, Perotti P, Filauro M, Maroldi R, Peretti G (2017) Role of imaging in the follow-up of T2–T3 glottic cancer treated by transoral laser microsurgery. Eur Arch Oto-Rhino-Laryngol 274:3679–3686. https://doi.org/10.1007/s00405-017-4642-4CrossRef

16.

Osuch-Wójcikiewicz E, Rzepakowska A, Sobol M, Bruzgielewicz A, Niemczyk K (2019) Oncological outcomes of CO2 laser cordectomies for glottic squamous cell carcinoma with respect to anterior commissure involvement and margin status. Lasers Surg Med 51:874–881. https://doi.org/10.1002/lsm.23130CrossRefPubMed

17.

Fiz I, Koelmel JC, Sittel C (2018) Nature and role of surgical margins in transoral laser microsurgery for early and intermediate glottic cancer. Curr Opin Otolaryngol Head Neck Surg 26:78–83. https://doi.org/10.1097/MOO.0000000000000446CrossRefPubMed

18.

Hendriksma M, Montagne MW, Langeveld TPM, Veselic M, van Benthem PPG, Sjögren EV (2018) Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO(2) laser microsurgery, on local control. Eur Arch Oto-Rhino-Laryngol 275:2333–2340. https://doi.org/10.1007/s00405-018-5070-9CrossRef

19.

Lucioni M, Bertolin A, D’Ascanio L, Rizzotto G (2012) Margin photocoagulation in laser surgery for early glottic cancer: impact on disease local control. Otolaryngol Head Neck Surg 146:600–605. https://doi.org/10.1177/0194599811433270CrossRefPubMed

20.

Ansarin M, Santoro L, Cattaneo A, Massaro MA, Calabrese L, Giugliano G, Maffini F, Ostuni A, Chiesa F (2009) Laser surgery for early glottic cancer: impact of margin status on local control and organ preservation. Arch Otolaryngol Head Neck Surg 135:385–390. https://doi.org/10.1001/archoto.2009.10CrossRefPubMed

21.

Jäckel MC, Ambrosch P, Martin A, Steiner W (2007) Impact of re-resection for inadequate margins on the prognosis of upper aerodigestive tract cancer treated by laser microsurgery. Laryngoscope 117:350–356. https://doi.org/10.1097/01.mlg.0000251165.48830.89CrossRefPubMed

22.

Mannelli G, Meccariello G, Deganello A, Maio V, Massi D, Gallo O (2014) Impact of low-thermal-injury devices on margin status in laryngeal cancer: an experimental ex vivo study. Oral Oncol 50:32–39. https://doi.org/10.1016/j.oraloncology.2013.10.001CrossRefPubMed

23.

Mariani C, Carta F, Tatti M, Marrosu V, Gerosa C, Puxeddu R (2021) Shrinkage of specimens after CO(2) laser cordectomy: an objective intraoperative evaluation. Eur Arch Oto-Rhino-Laryngol 278:1515–1521. https://doi.org/10.1007/s00405-021-06625-8CrossRef

24.

Hans S, Crevier-Buchman L, Circiu M, Idrissi YC, Distinguin L, de Mones E, Brasnu D, Lechien JR (2021) Oncological and surgical outcomes of patients treated by transoral CO(2) laser cordectomy for early-stage glottic squamous cell carcinoma: a retrospective chart review. Ear Nose Throat J 100:33S-37S. https://doi.org/10.1177/0145561320911486CrossRefPubMed

25.

Simo R, Bradley P, Chevalier D, Dikkers F, Eckel H, Matar N, Peretti G, Piazza C, Remacle M, Quer M (2014) European Laryngological Society: ELS recommendations for the follow-up of patients treated for laryngeal cancer. Eur Arch Otorhinolaryngol 271:2469–2479. https://doi.org/10.1007/s00405-014-2966-xCrossRefPubMed

26.

Hanna J, Brauer PR, Morse E, Mehra S (2019) Margins in laryngeal squamous cell carcinoma treated with transoral laser microsurgery: a national database study. Otolaryngol Neck Surg 161:986–992. https://doi.org/10.1177/0194599819874315CrossRef

27.

Piazza C, Paderno A, Grazioli P, Del Bon F, Montalto N, Perotti P, Morello R, Filauro M, Nicolai P, Peretti G (2018) Laryngeal exposure and margin status in glottic cancer treated by transoral laser microsurgery. Laryngoscope 128:1146–1151. https://doi.org/10.1002/lary.26861CrossRefPubMed

28.

Verro B, Greco G, Chianetta E, Saraniti C (2021) Management of early glottic cancer treated by CO2 laser according to surgical-margin status: a systematic review of the literature. Int Arch Otorhinolaryngol 25:e301–e308. https://doi.org/10.1055/s-0040-1713922CrossRefPubMed

29.

McInnes M, Moher D, Thombs B, McGrath T, Bossuyt P, Clifford T, Cohen J, Deeks J, Gatsonis C, Hooft L et al (2018) Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies the PRISMA-DTA statement. JAMA 319:388–396. https://doi.org/10.1001/jama.2017.19163CrossRefPubMed

30.

Lydiatt WM, Patel SG, Ridge JA, O’Sullivan B, Shah JP (2017) Staging head and neck cancers

31.

Melnyk BMM, Fineout-Overholt E (2023) Evidence-based practice in nursing & healthcare: a guide to best practice. Lippincott Williams & Wilkins, Philadelphia

32.

Altman DG, McShane LM, Sauerbrei W, Taube SE (2012) Reporting recommendations for tumor marker prognostic studies (REMARK): explanation and elaboration. PLoS Med 9:e1001216. https://doi.org/10.1371/journal.pmed.1001216CrossRefPubMedPubMedCentral

33.

Djukic V, Milovanović J, Jotić AD, Vukasinovic M, Folic MM, Ivanov SY, Satueva DB (2019) Laser transoral microsurgery in treatment of early laryngeal carcinoma. Eur Arch Oto-Rhino-Laryngol 276:1747–1755. https://doi.org/10.1007/s00405-019-05453-1CrossRef

34.

Peretti G, Bolzoni A, Parrinello G, Mensi MC, Shapshay SM, Piazza C, Rossini M, Antonelli AR (2004) Analysis of recurrences in 322 Tis, Tl, or T2 glottic carcinomas treated by carbon dioxide laser. Ann Otol Rhinol Laryngol 113:853CrossRefPubMed

35.

Pedregal-Mallo D, Sánchez Canteli M, López F, Álvarez-Marcos C, Llorente JL, Rodrigo JP (2018) Oncological and functional outcomes of transoral laser surgery for laryngeal carcinoma. Eur Arch Oto-Rhino-Laryngol 275:2071–2077. https://doi.org/10.1007/s00405-018-5027-zCrossRef

36.

Dyckhoff G, Warta R, Herold-Mende C, Rudolph E, Plinkert PK, Ramroth H (2021) An Observational cohort study on 194 supraglottic cancer patients: implications for laser surgery and adjuvant treatment. Cancers 13:1–14. https://doi.org/10.3390/cancers13030568CrossRef

37.

Vilaseca I, Aviles-Jurado FX, Valduvieco I, Berenguer J, Grau JJ, Baste N, Muxí Á, Castillo P, Lehrer E, Jordana M et al (2021) Transoral laser microsurgery in locally advanced laryngeal cancer: prognostic impact of anterior versus posterior compartments. Head Neck 43:3832–3842. https://doi.org/10.1002/hed.26878CrossRefPubMed

38.

Jumaily M, Faraji F, Osazuwa-Peters N, Walker RJ, Ward GM (2019) Prognostic significance of surgical margins after transoral laser microsurgery for early-stage glottic squamous cell carcinoma. Oral Oncol 97:105–111. https://doi.org/10.1016/j.oraloncology.2019.08.005CrossRefPubMed

39.

Ansarin M, Cattaneo A, De Benedetto L, Zorzi S, Lombardi F, Alterio D, Rocca MC, Scelsi D, Preda L, Chiesa F et al (2017) Retrospective analysis of factors influencing oncologic outcome in 590 patients with early-intermediate glottic cancer treated by transoral laser microsurgery. Head Neck 39:71–81. https://doi.org/10.1002/hed.24534CrossRefPubMed

40.

Shoffel-Havakuk H, Lahav Y, Davidi ES, Haimovich Y, Hain M, Halperin D (2016) The role of separate margins sampling in endoscopic laser surgery for early glottic cancer. Acta Otolaryngol 136:491–496. https://doi.org/10.3109/00016489.2015.1132843CrossRefPubMed

41.

Piazza C, Barbieri D, Del Bon F, Grazioli P, Perotti P, Paderno A, Frittoli B, Mazza G, Penco S, Gaggero G et al (2016) Functional outcomes after different types of transoral supraglottic laryngectomy. Laryngoscope 126:1131–1135. https://doi.org/10.1002/lary.25562CrossRefPubMed

42.

Blanch J’-L, Vilaseca I, Caballero M, Moragas M, Berenguer J, Bernal-Sprekelsen M (2011) Outcome of transoral laser microsurgery for T2–T3 tumors growing in the laryngeal anterior commissure. Head Neck 10:1252–1259. https://doi.org/10.1002/hedCrossRef

43.

Remacle M, Eckel HE, Antonelli A, Brasnu D, Chevalier D, Friedrich G, Olofsson J, Rudert HH, Thumfart W, de Vincentiis M et al (2000) Endoscopic cordectomy: a proposal for a classification by the Working Committee, European Laryngological Society. Eur Arch Otorhinolaryngol 257:227–231. https://doi.org/10.1007/s004050050228CrossRefPubMed

44.

Brøndbo K, Fridrich K, Boysen M (2007) Laser surgery of T1a glottic carcinomas; significance of resection margins. Eur Arch Oto-Rhino-Laryngol 264:627–630. https://doi.org/10.1007/s00405-006-0233-5CrossRef

45.

Buchanan MA, Coleman HG, Daley J, Digges J, Sandler M, Riffat F, Palme CE (2016) Relationship between CO₂ laser-induced artifact and glottic cancer surgical margins at variable power doses. Head Neck 38(Suppl 1):E712–E716. https://doi.org/10.1002/hed.24076CrossRefPubMed

46.

Lee HS, Chun B-G, Kim SW, Kim ST, Oh JH, Hong JC, Lee KD (2013) Transoral laser microsurgery for early glottic cancer as one-stage single-modality therapy. Laryngoscope 123:2670–2674. https://doi.org/10.1002/lary.24080CrossRefPubMed

47.

Charbonnier Q, Thisse A-S, Sleghem L, Mouawad F, Chevalier D, Page C, Mortuaire G (2016) Oncologic outcomes of patients with positive margins after laser cordectomy for T1 and T2 glottic squamous cell carcinoma. Head Neck 38:1804–1809. https://doi.org/10.1002/hed.24518CrossRefPubMed

48.

Mariani C, Carta F, Bontempi M, Marrosu V, Tatti M, Pinto V, Gerosa C, Puxeddu R (2023) Management and oncologic outcomes of close and positive margins after transoral CO₂ laser microsurgery for early glottic carcinoma. Cancers. https://doi.org/10.3390/cancers15051490CrossRefPubMedPubMedCentral

49.

Piazza C, Cocco D, De Benedetto L, Del Bon F, Nicolai P, Peretti G (2010) Narrow Band imaging and high definition television in the assessment of laryngeal cancer: a prospective study on 279 patients. Eur Arch Oto-Rhino-Laryngol 267:409–414. https://doi.org/10.1007/s00405-009-1121-6CrossRef

50.

Aluffi Valletti P, Taranto F, Chiesa A, Pia F, Valente G (2018) Impact of resection margin status on oncological outcomes after CO₂ laser cordectomy. Acta Otorhinolaryngol Ital 38:24–30. https://doi.org/10.14639/0392-100X-870CrossRefPubMed

51.

Vander Poorten V, Meulemans J, Van Lierde C, Nuyts S, Delaere P (2021) Current indications for adjuvant treatment following transoral laser microsurgery of early and intermediate laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 29:79–85. https://doi.org/10.1097/MOO.0000000000000702CrossRefPubMed

52.

Remacle M, Hantzakos A, Eckel H, Evrard A-S, Bradley PJ, Chevalier D, Djukic V, de Vincentiis M, Friedrich G, Olofsson J et al (2009) Endoscopic supraglottic laryngectomy: a proposal for a classification by the working committee on nomenclature, European Laryngological Society. Eur Arch Oto-Rhino-Laryngol 266:993–998. https://doi.org/10.1007/s00405-008-0901-8CrossRef

53.

Maroldi R, Ravanelli M, Farina D (2014) Magnetic resonance for laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 22:131–139. https://doi.org/10.1097/MOO.0000000000000036CrossRefPubMed

54.

Becker M, Casselman JW, Kohler R, Dulguerov P, Becker CD (2008) Neoplastic invasion of laryngeal cartilage: reassessment of criteria for diagnosis at MR imaging 1. Radiology 249:551–559CrossRefPubMed

55.

Brook I (2021) Early side effects of radiation treatment for head and neck cancer. Cancer Radiother J Soc Fr Radiother Oncol 25:507–513. https://doi.org/10.1016/j.canrad.2021.02.001CrossRef

56.

Gessert TG, Britt CJ, Maas AMW, Wieland AM, Harari PM, Hartig GK (2017) Chondroradionecrosis of the larynx: 24-year University of Wisconsin experience. Head Neck 39:1189–1194. https://doi.org/10.1002/hed.24749CrossRefPubMed

57.

Reale M, Bardon ML, Ciavarro G, Pedrazzi G, Santoro GP (2023) Value and role of surgical margins in transoral laser microsurgery of the larynx, literature review and clinical considerations. Eur Arch Oto-Rhino-Laryngol. https://doi.org/10.1007/s00405-023-08238-9CrossRef

Title: The impact of margins in laryngeal cancer patients treated with transoral laser microsurgery: a systematic review and meta-analysis
Authors: Andrea Iandelli
Giulia Gabella
Filippo Marchi
Valentina Campagnari
Marta Filauro
Claudio Sampieri
Tsung-You Tsai
Isabel Vilaseca
Giorgio Peretti
Publication date: 02-04-2024
Publisher: Springer Berlin Heidelberg
Keywords: Laryngeal Cancer
Laryngeal Cancer
Laser
Published in: European Archives of Oto-Rhino-Laryngology
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-024-08610-3

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Data sources

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Data sources

Methods

Results

Conclusions

Please log in to get access to this content