Frozen margin analysis as a prognosis predictor in early glottic cancer by laser cordectomy.

OBJECTIVES/HYPOTHESIS: The impact of margin status on the outcomes of early glottic cancer after endoscopic resection is controversial; second look laryngoscopy has shown a low rate of residual cancer, even in margin positive patients. Intraoperative frozen section analysis has been suggested as an alternative to routine second look procedures. The aim of this study was to evaluate and search for predictors of outcomes in patients following endoscopic resection based on intraoperative frozen section margin analysis.

STUDY DESIGN

Retrospective chart review.

METHODS

Records of consecutive patients treated for early glottic cancer by endoscopic resection with the CO2 laser were evaluated for margin status at the time of intervention, disease recurrence rate, and survival data. Kaplan-Meir survival rates were determined and subgroups were compared with log-rank test and Chi-square test.

RESULTS

From February 2004 to September 2011, 75 consecutive patients with complete records were identified. The 5-year overall survival rate and the disease-specific survival rate are 84 and 98%, respectively. Recurrence within 12 months (P = 0.019) and initially positive frozen section margins, despite enlarging the cordectomy field to obtain negative margins (P = 0.001), were determined to be predictors for poor overall survival.

CONCLUSIONS

In endoscopic resection of early glottic cancer with the CO2 laser, initial intraoperative frozen section margin involvement during the primary resection and early local recurrence are poor signs for overall survival.

LEVEL OF EVIDENCE