Prognostic importance of surgical margins in advanced laryngeal squamous carcinoma

The prognostic significance of the status of surgical margins remains unclear in patients with cancer of the larynx.

To further evaluate this issue, a cohort of 159 surgically treated patients with advanced (stage III, IV) squamous carcinoma of the larynx who were part of a prospective multi-institutional clinical trial (VA Laryngeal Cancer Study Group) were studied.

All patients underwent total laryngectomy (n = 144) or supraglottic laryngectomy (n = 15) followed by radiotherapy. Surgical margins were assessed intraoperatively and reported on final pathology as either clear (n = 134), tumor within 5-10 mm of the surgical margin (n = 6), less than 5 mm from the surgical margin (n = 8), or involved (n = 11). Postoperative complications, especially fistula rates, were significantly associated with margin status (p = .04 and p = .004, respectively). No significant differences were detected in patterns of recurrence (p = .584) or time to recurrence (p = .712) according to margin status. Patients with close or involved margins received significantly higher doses of radiation (p = .0017), as prescribed in the protocol. Patient survival percentages were 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 with wider margins tended to have prolonged disease-free survival (p = .1413) and overall survival (p = .1879).

Despite the small number of patients with histologically proven close margins (16%) in this trial, the data suggest that high-dose postoperative radiation does not eliminate the benefit of obtaining widely clear surgical margins. Better methods of assessing and obtaining wide surgical margins may translate into added survival benefit and lower complication rates.