Tumor clearance at resection margins in total laryngectomy. A clinicopathologic study

The specimens from total laryngectomy performed in 70 patients were studied using the step-serial whole organ sectioning technique. Transverse histologic sections were taken and examined for minimum tumor clearance. The clinical status of patients for at least 4 years of observation was correlated with microscopic clearance of margins. The actual presence of tumor at the margins of resection was found in 21 (30%) of the specimens. The tumor was found to reach within 1 mm, 2 mm, and more than 2 mm from the margins in nine (13%), four (6%), and 36 (51%) specimens, respectively. The anterolateral margin was most commonly involved (19%), followed by the posterolateral (11%), postcricoid (7%), and upper (1.4%) margins. Local recurrence was found to be related to degree of clearance as 10 of 21 (48%) patients with no clearance and one of nine (11%) with 1 mm clearance had local failure. None of the patients with 2 mm clearance or more developed local recurrence. It is concluded that step-serial whole organ sectioning is an adequate method for thoroughly examining resection margins in laryngectomy specimens.