Assessment of margins in transoral laser and robotic surgery.

Thomas Shpitzer,Daniel Brasnu,Yaniv Hamzany,Jacob Shvero

doi:10.5041/rmmj.10150

Abstract

The growing practice of endoscopic surgery has changed the therapeutic management of selected head and neck cancers. Although a negative surgical margin in resection of neoplasm is the most important surgical principle in oncologic surgery, controversies exist regarding assessment and interpretation of the status of margin resection. The aim of this review was to summarize the literature considering the assessment and feasibility of negative margins in transoral laser microsurgery (TLM) and transoral robotic surgery (TORS). Free margin status is being approached differently in vocal cord cancer (1–2 mm) compared with other sites in the upper aerodigestive tract (2–5 mm). Exposure, orientation of the pathological specimen, and co-operation with the pathologist are crucial principles needed to be followed in transoral surgery. Piecemeal resection to better expose deep tumor involvement and biopsies taken from surgical margins surrounding site of resection can improve margin assessment. High rates of negative surgical margins can be achieved with TLM and TORS. Adjuvant treatment decision should take into consideration also the surgeon’s judgment with regard to the completeness of tumor resection.

Highlights

A negative surgical margin in resection of neoplasm is well recognized as the most important surgical principle in oncologic surgery.[1]
Strong described the first use of endoscopic CO2 laser resection of glottic cancer in 1975.2 With further development over the decades, the technique became one of the mainstay treatments for early laryngeal cancer.[3,4,5,6]
Transoral laser microsurgery is minimally invasive and is performed under direct suspension laryngoscopy with an operating microscope that grants the surgeon a high-power magnification of vision, a superior detailed quality compared to that obtained by external approach

Summary

INTRODUCTION

A negative surgical margin in resection of neoplasm is well recognized as the most important surgical principle in oncologic surgery.[1]. There is no unanimity about the size and the method to assess the healthy tissue surrounding the tumor. Ambiguous terms such as “close margin” or “inconclusive” further contribute to the unclarity of margin evaluation and decision-making. Strong described the first use of endoscopic CO2 laser resection of glottic cancer in 1975.2 With further development over the decades, the technique became one of the mainstay treatments for early laryngeal cancer.[3,4,5,6] Transoral robotic surgery (TORS) for the resection of supraglottic cancer was introduced in 2007 by Weinstein et al.[7] overcoming some of the limitations concerning visualization, maneuvering, and accessibility in transoral laser microsurgery (TLM). The aim of this review was to summarize the literature considering the assessment and feasibility of negative margins in transoral laser and robotic surgery

BASIC PRINCIPLES IN ENDOSCOPIC SURGERY

Frozen Section

Optical and Molecular Techniques

Findings

CONCLUSION