Laryngeal exposure and margin status in glottic cancer treated by transoral laser microsurgery

Objective: Laryngeal exposure is one of the most limiting factors in transoral laser microsurgery (TLM) for glottic cancer. We evaluated the correlation between the degree of laryngeal exposure, as assessed by an easy previously described scoring tool (Laryngoscore), and histopathologic surgical margin status after TLM. Study Design: Prospective evaluation of 147 patients affected by Tis–T2 glottic cancer treated by TLM with curative intent between January 2012 and April 2016. Methods: All patients were preoperatively assessed and classified as having good (group A including Laryngoscore class 0–I) or suboptimal laryngeal exposure (group B including class II–III). Margins were classified as negative (more than 1 mm margin between healthy tissue and tumor) or positive (one/multiple superficial or deep margins involved by invasive or in situ carcinoma). Patients with multiple superficial or deep margin positivity were scheduled for TLM re-excision, open partial laryngectomy, or postoperative radiotherapy. Results: Twenty-one type I, 54 type II, 19 type III, 7 type IV, 41 type V, and 5 type VI cordectomies (according to the European Laryngological Society classification) were performed with an en-bloc or multi-bloc technique according to the size, site, and exposure of the lesion. Group A included 109 (74%) and group B included 38 (26%) patients. Positive surgical margins were overall observed in 39 (26.5%) cases: 21 (19.2%) in group A versus 18 (47.4%) in group B (P = 0.001). Conclusion: Laryngeal exposure is one of the most important factors influencing TLM resection of glottic cancer within safe surgical margins. The importance of its adequate preoperative assessment cannot be overemphasized. Level of Evidence: 2b. Laryngoscope, 128:1146–1151, 2018.