Margin Status is not Associated with Recurrence and Survival Outcomes in Advanced Laryngeal Malignancies

Introduction: Surgery remains one of the most important cornerstones in the management of advanced laryngeal and hypopharyngeal malignancies. The goal of surgery to achieve complete tumor removal with clear margins. The Royal College of Pathologists defines clear margins as greater than 5mm, and close margins less than 5mm. For laryngeal and hypopharyngeal malignancies these resection margins can be difficult to achieve due to critical surrounding structures such as mucosa, skin, prevertebral structures and critical neurovascular structures. It is important to balance margin control while sparing healthy tissues. The aim of the present study is to evaluate the impact that margins have to recurrence free and overall survival.

Methods: A single center cohort study was carried out over a 10-year period. Patients met inclusion criteria if they underwent a laryngectomy or pharyngolaryngectomy for a squamous cell carcinoma of the larynx. Data collected included pathological factors, surgical characteristics, margin status, recurrence and overall survival.

Results: A total of 173 patients met inclusion criteria and were available for analysis. The mean age of the cohort was 63.7 years. The larynx was the most common primary site (84%), and salvage surgery was performed in 36% of cases. Close or involved margins were more likely with advanced laryngeal cancers and salvage surgery cases (p < 0.001). Univariate logistic regression analysis did not find a difference in rates of recurrence over a 10-year time period with clear, close or involved margins. Salvage surgery was the only factor that influenced the risk of recurrence (p=0.012). The 10-year disease-free survival rate was 64%, and 10-year overall survival was 41%. Margin status did not influence disease-free or overall survival (p=0.491, 0.686 respectively).

Conclusions: Data from the present study demonstrates good disease-control rates and overall survival, independent of margin status. This data supports reconsideration for what an adequate margin for advanced laryngeal and hypopharyngeal malignancies should be.