International Journal of Phonosurgery & Laryngology

Register      Login

VOLUME 1 , ISSUE 2 ( July-December, 2011 ) > List of Articles

RESEARCH ARTICLE

Reliability of Frozen Section Analysis in Transoral Laser Microsurgery of Upper Aerodigestive Tract Advanced Malignant Tumors

Nayla Matar, Georges Lawson, Marc Remacle, Marie-Cécile Nollevaux, Monique Delos, Jacques Jamart

Citation Information : Matar N, Lawson G, Remacle M, Nollevaux M, Delos M, Jamart J. Reliability of Frozen Section Analysis in Transoral Laser Microsurgery of Upper Aerodigestive Tract Advanced Malignant Tumors. Int J Phonosurg Laryngol 2011; 1 (2):44-46.

DOI: 10.5005/jp-journals-10023-1011

Published Online: 01-12-2014

Copyright Statement:  Copyright © 2011; The Author(s).


Abstract

Objective

Transoral laser microsurgery (TLM) for endoscopic excision of head and neck cancers of the upper aerodigestive tract has become an accepted treatment modality. As in any excision of head and neck tumors, the persistance of tumor at the surgical margins influences the outcome. One of the frequent criticisms of endoscopic resection is that the laser use makes interpretation of the surgical margins difficult due to the thermal effect. The goal of this study is to assess the reliability of frozen section after laser excision in locally advanced tumors.

Methods

The charts of patients with T2 and T3 tumors, who underwent TLM between January 2000 and 2008, using the CO2 laser AcuBlade system were reviewed. Frozen section margin results obtained during TLM were compared with margins after formalin fixation.

Results

Sixty-seven patients fulfilled the inclusion criteria. 20 had supraglottic tumors, 22 had oral cavity tumors, 13 had oropharyngeal tumors and 12 had hypopharyngeal tumors. Fifty-nine had no prior treatment, seven had prior radiation therapy and one had prior open surgery. The mean number of frozen margins per surgery was 4. Histological examination on the formalin-fixed tissue confirmed frozen section in 97% of the cases. In 3% of the frozen sections, the diagnosis of invasive carcinoma was missed. None of these patients had significant locoregional disease progression.

Conclusion

Frozen section analysis of margins is reliable during TLM when performed by an experienced team. It enables a one-stage approach reducing the need of a planned second procedure.


PDF Share
  1. Laser surgery in the larynx: Early clinical experience with continuous CO2 laser. Ann Otol Rhinol Laryngol 1972;81:791.
  2. Twenty-five years experience with laser surgery for head and neck tumors. Report of an international symposium, Göttingen, Germany (2005). Eur Arch Otorhinolaryngol 2007;264:577-85.
  3. The histologic reliability of laser cone biopsy of the cervix. Obstet Gynecol 1991; 77(6):905-11.
  4. Impact of re-resection for inadequate margins on the prognosis of upper aerodigestive tract cancer treated by laser microsurgery. Laryngoscope 2007;117(2):350-56.
  5. Non parametric estimation from incomplete observations. J Amer Stat Assoc 1958;53:457-81.
  6. Transoral laser surgery for laryngeal cancer: Outcome, complications and prognostic factors in 275 patients. Eur J Surg Oncol 2009;35(3):235-40.
  7. Endoscopic CO2 laser surgery in vocal cord cancer. Diagn Ther Endosc 1994;1(2):69-74.
  8. Transoral laser microresection for cancer of the larynx involving the anterior commissure. Laryngoscope 2003;113:1104-12.
  9. Results of curative laser microsurgery of laryngeal carcinomas. Am J Otolaryngol 1993;14:116-21.
  10. Complications in transoral CO2 laser surgery for carcinoma of the larynx and hypopharynx. Head Neck 2003;25:382-88.
  11. Laser cordotomy versus radiotherapy: An objective cost analysis. Ann Otol Rhinol Laryngol 2001; 110:312-18.
  12. Endoscopic cordectomy: A proposal for a classifation by the working committee, European Laryngological Society. Eur Arch Otorhinolaryngol 2000;257(4):227-31.
  13. Proposal for revision of the European Laryngological Society classification of endoscopic cordectomies. Eur Arch Otorhinolaryngol 2007;264:499-504.
  14. Role of margin status in recurrence after CO2 laser endoscopic resection of early glottic cancer. Acta Oto-Laryngologica 2006;126:306-10.
  15. Transoral laser surgery of supraglottic cancer. Arch Otolaryngol Head Neck Surg 1998;124:1245-50.
  16. Accuracy of histological examination following endoscopic CO2 laser assisted laryngectomy. Otorhinolaryngol Nova 2002;12:16-20.
  17. The uncertainty of surgical margins in the treatment of head and neck cancer. Oral Oncology 2007;43:321-26.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.