Abstract
ObjectiveTo compare the suitability of CO2 laser with steel instruments for margin excision in transoral laser microsurgery.MethodsProspective randomized blinded study. Patients with glottic cancer undergoing laser resection were randomized to margin excision by either steel instruments or CO2 laser. Margins were analyzed for size, interpretability and degree of artifact by a pathologist who was blinded to technique.Results45 patients were enrolled in the study with 226 total margins taken. 39 margins taken by laser had marked artifact and 0 were uninterpretable. 20 margins taken by steel instruments had marked artifact, and 2 were uninterpretable. Controlling for margin size, the laser technique was associated with increasing degrees of margin artifact (p = 0.210), but there was no difference in crude rates of uninterpretability (p = 0.24).ConclusionLaser margin excision is associated with a greater degree of artifact than steel instrument excision, but was not associated with higher rate of uninterpretability.
Highlights
In 1972, Strong and Jako were the first to report the use of transoral laser microsurgery (TLM) in the treatment of glottic cancer [1]
The study cohort was composed of 45 patients with 23 randomized to have margins taken by CO2 laser and 22 randomized to have margins taken with steel phonomicrosurgical instruments
Primary analysis There were no margins taken by laser (n=115) that were uninterpretable (0%), and 2 margins taken by steel instruments (n=111) that were uninterpretable (1.8%)
Summary
In 1972, Strong and Jako were the first to report the use of transoral laser microsurgery (TLM) in the treatment of glottic cancer [1]. TLM has become one of the primary modalities in the treatment of early glottic cancer [6,7,8,9,10]. In TLM, as with the rest of head and neck cancer surgery, local control is maximized by complete excision with adequate margins. Positive margin status in glottic cancer has been associated with increased risk of local recurrence and poorer prognosis [11,12,13,14].
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