Histopathological examination of margins in transoral laser microsurgery for early glottic carinoma: the value of details

In the present research we evaluated which factors could possibly influence the oncological outcomes of patients treated with conservative surgery for early glottic SCC. TLM provides good functional preservation and tumour control and allows for a range of salvage treatment in case of disease persistence or relapse. The histopathological evaluation of TLM samples is essential for tumour staging and classification, however there is no agreement among otolaryngologists on the best treatment choice for patients with histologically positive margins. Transoral endoscopic CO2 laser surgery is to this day the first choice used for the treatment of early stage glottic carcinomas due to both its efficacy and encouraging oncological results. On the other hand, the management of positive surgical margins following laser cordectomy is still controversial. The aim of this study is to analyse a retrospective series of TLM performed for early glottic SCC focusing on the histopathological examination of surgical margins, to assess: 1. The overall incidence of positive margins and their characteristics 2. The oncological outcomes associated with specific margin involvement 3. The impact of salvage therapy on these outcomes. We retrospectively evaluated data from patients affected by glottic SCC and severe dysplasia, treated by TLM. The prognostic relevance of a detailed histopathological evaluation highlighted by our results stresses the importance of a standardized and reproducible approach to TLM sample orientation and processing.