Assessment of Margins in Transoral Laser and Robotic Surgery

Overview

Journal Rambam Maimonides Med J

Specialty General Medicine

Date 2014 May 9

PMID 24808954

Citations 5

Authors

Yaniv Hamzany

Daniel Brasnu

Thomas Shpitzer

Jacob Shvero

Affiliations

Soon will be listed here.

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.

Citing Articles

Transtumoral approach and piecemeal resection (Steiner principle) for the treatment of tongue cancer at stage T1-T2: A pilot study.

Luna-Ortiz K, Guillen-Hernandez G, Caro-Sanchez C, Luna-Peteuil Z, Cano-Valdez A, Garcia-Ortega D Med Oral Patol Oral Cir Bucal. 2024; 29(5):e704-e710.

PMID: 39088717 PMC: 11365059. DOI: 10.4317/medoral.26696.

Oncological and functional outcomes for transoral robotic surgery following previous radiation treatment for upper aerodigestive tract head and neck cancers. A French multicenter GETTEC group study.

Malard O, Karakachoff M, Ferron C, Hans S, Vergez S, Garrel R Cancer Med. 2024; 13(7):e7031.

PMID: 38545809 PMC: 10974718. DOI: 10.1002/cam4.7031.

Clarification of the margin status by the multidisciplinary tumor board following transoral robotic surgery for p16 positive oropharyngeal squamous cell carcinoma.

Parvathaneni A, Patel S, Houlton J, Pang J, Futran N Laryngoscope Investig Otolaryngol. 2023; 8(6):1500-1506.

PMID: 38130253 PMC: 10731506. DOI: 10.1002/lio2.1163.

Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO laser microsurgery, on local control.

Hendriksma M, Montagne M, Langeveld T, Veselic M, van Benthem P, Sjogren E Eur Arch Otorhinolaryngol. 2018; 275(9):2333-2340.

PMID: 30027440 PMC: 6096566. DOI: 10.1007/s00405-018-5070-9.

Early Oral Tongue Squamous Cell Carcinoma: Sampling of Margins From Tumor Bed and Worse Local Control.

Maxwell J, Thompson L, Brandwein-Gensler M, Weiss B, Canis M, Purgina B JAMA Otolaryngol Head Neck Surg. 2015; 141(12):1104-10.

PMID: 26225798 PMC: 5242089. DOI: 10.1001/jamaoto.2015.1351.

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