MANAGEMENT OF PATIENTS WITH POSITIVE SURGICAL MARGINS AFTER VERTICAL HEMILARYNGECTOMY

Objective: To evaluate the significance of positive surgical margins a fter vertical hemilaryngectomy for squamous cell carcinoma of the lary nx. Design: A retrospective review of patients undergoing hemilaryngec tomy over a 20-year period. Setting: A major academic medical center. Patients: Fifty-six consecutive patients who underwent hemilaryngectom y between 1970 and 1990. Seventeen patients were excluded because of i nsufficient data or because they received postoperative radiation ther apy. Results: Eleven (28%) of 39 patients had cancer involvement of at least one margin. Two (8%) of 28 patients with negative margins and s ix (55%) of 11 patients with positive margins had recurrence. This dif ference in tumor recurrence is statistically significant. The mean dis ease-free interval prior to recurrence was 25 months, with no signific ant difference between the two groups. The mean followup periods for p atients with positive vs negative margins were not statistically signi ficant. There were no significant differences in survival estimates be tween patients with positive margins and those with negative margins.C onclusions: Despite a sevenfold increase in tumor recurrence rates for patients with positive margins after hemilaryngectomy, there was no a dverse effect on overall survival when these patients were managed wit h close follow-up and salvage surgery with or without postoperative ra diation therapy for tumor recurrence.