Positive surgical margins in cancer of the larynx

In order to determine what should be done for laryngeal cancer patients whe n surgical margins are positive, and to evaluate their prognosis, a retrosp ective review of 21 laryngeal cancer patients with positive surgical margin s out of 714 surgically treated cases (2.9%) was carried out. Nineteen pati ents were treated with postoperative radiation therapy. Two patients who ha d had endolaryngeal partial laryngectomy were treated with vertical partial laryngectomy. Two patients were lost to follow-up. Ten patients (10/19; 53 %) were recurrence-free. Four patients had local, two had regional, and two had locoregional recurrences. Only one patient with a local recurrence cou ld be salvaged with total laryngectomy and is disease-free. One patient dev eloped liver metastasis. Nineteen patients had a mean and median disease-fr ee survival of 48 and 36 months, respectively. Nine out of fourteen patient s (64%) treated curatively were recurrence-free. The patients with positive margins developed significantly more locoregional recurrences than those w ith free margins (P < 0.05). We conclude that surgical margins must be chec ked peroperatively with frozen sections to make sure that they are free. Th e margins of every laryngectomy specimen must be diligently examined. If po sitive, re-excision, postoperative radiotherapy and chemotherapy are treatm ent alternatives. They should not just be managed with close follow-up. How ever, whatever treatment is applied, the prognosis for patients with positi ve margins is significantly worse than for those with free margins.