Verro Barbara, Greco Giuseppe, Chianetta Enzo, Saraniti Carmelo
Department of Biomedicine, Neuroscience and Advanced Diagnostics, ENT Clinic, University of Palermo, Palermo, Italy.
Int Arch Otorhinolaryngol. 2021 Apr;25(2):e301-e308. doi: 10.1055/s-0040-1713922. Epub 2020 Sep 24.
Transoral laser microsurgery (TLM) is the treatment of choice for Tis-T2 squamous cell glottic carcinomas due to its advantages compared with open surgery and radiotherapy. However, the CO laser beam causes changes and damage on the specimens, making the histological assessment of resection margins, the gold standard for confirming radical tumor resection, sometimes difficult. To assess the different ways to manage patients depending on the status of the histopathological margin according to recent studies to detect the most commonly shared therapeutic strategy. We analyzed the literature available on the PubMed and Web of Science databases, including only articles published since 2005, using specific keywords to retrieve articles whose titles and abstracts were read and analyzed independently by two authors to detect relevant studies. Therefore, we focused on disease-free survival, overall survival, local control, laryngeal preservation, and disease-specific survival. Thus, 17 studies were included in the present review; they were grouped according to the status of the histological margin, and we analyzed the different management policies described in them. This analysis showed that there is not a shared strategy, though in most studies the authors performed a second-look surgery in the cases of positive margins and a close follow-up in cases of negative ones. The main disagreement is regarding the management of close or non-valuable resection margins, since some some authors performed a second-look surgery, and others, a close follow-up. Definitely, the most shared policy is the second-look surgery in case of positive surgical margins, and a close follow-up in case of close or non-valuable resection margins. To date, TLM is the treatment of choice for Tis-T2 squamous cell glottic carcinomas. The CO laser beam could impair the histological assessment of the resection margins, which is the gold standard to confirm radical tumor resection. Second-look TLM is the most performed strategy in case of positive surgical margins.Close follow-up is the most shared policy in case of close or non-valuable resection margins.In cases of negative resection margins, follow-up represents the best approach.
经口激光显微手术（TLM）由于与开放手术和放射治疗相比具有优势，是Tis-T2期声门鳞状细胞癌的首选治疗方法。然而，CO₂激光束会对标本造成改变和损伤，使得作为确认肿瘤根治性切除金标准的手术切缘组织学评估有时变得困难。
根据近期研究评估根据组织病理学切缘状态管理患者的不同方法，以找出最常用的治疗策略。
我们分析了PubMed和Web of Science数据库中自2005年以来发表的文献，使用特定关键词检索文章，其标题和摘要由两位作者独立阅读和分析以找出相关研究。因此，我们关注无病生存期、总生存期、局部控制、喉保留率和疾病特异性生存期。本综述纳入了17项研究；它们根据组织学切缘状态进行分组，我们分析了其中描述的不同管理策略。该分析表明，虽然在大多数研究中，作者对切缘阳性的病例进行了二次手术，对切缘阴性的病例进行了密切随访，但并没有共同的策略。主要分歧在于对切缘接近或无法评估的处理，因为一些作者进行了二次手术，而另一些作者则进行了密切随访。
肯定地说，最常用的策略是手术切缘阳性时进行二次手术，切缘接近或无法评估时进行密切随访。迄今为止，TLM是Tis-T2期声门鳞状细胞癌的首选治疗方法。CO₂激光束可能会损害手术切缘的组织学评估，而手术切缘评估是确认肿瘤根治性切除的金标准。手术切缘阳性时，二次TLM是最常采用的策略。切缘接近或无法评估时，密切随访是最常用的策略。手术切缘阴性时，随访是最佳方法。
