PROGNOSTIC IMPORTANCE OF SURGICAL MARGINS IN ADVANCED LARYNGEAL SQUAMOUS CARCINOMA

Background. The prognostic significance of the status of surgical marg ins remains unclear in patients with cancer of the larynx. Methods. To further evaluate this issue, a cohort of 159 surgically treated patie nts with advanced (stage III, IV) squamous carcinoma of the larynx who were part of a prospective multi-institutional clinical trial (VA Lar yngeal Cancer Study Group) were studied. Results. All patients underwe nt total laryngectomy (n 144) or supraglottic laryngectomy (n = 15) fo llowed by radiotherapy. Surgical margins were assessed intraoperativel y and reported on final pathology as either clear (n = 134), tumor wit hin 5-10 mm of the surgical margin (n = 6), less than 5 mm from the su rgical margin (n = 8), or involved (n = 11). Postoperative complicatio ns, especially fistula rates, were significantly associated with margi n status (p = .04 and p = .004, respectively). No significant differen ces were detected in patterns of recurrence (p = .584) or time to recu rrence (p = .712) according to margin status. Patients with close or i nvolved margins received significantly higher doses of radiation (p = .0017), as prescribed in the protocol. Patient survival percentages we re 50% for clear margins, 57% for close margins, and 27% for involved margins (p = .286). When grouped by margins >5 mm or <5 mm, patients w ith wider margins tended to have prolonged disease-free survival (p = .1413) and overall survival (p = .1879). Conclusions, Despite the smal l number of patients with histologically proven close margins (16%) in this trial, the data suggest that high-dose postoperative radiation d oes not eliminate the benefit of obtaining widely clear surgical margi ns. Better methods of assessing and obtaining wide surgical margins ma y translate into added survival benefit and lower complication rates. (C) 1996 John Wiley & Sons, Inc.