title: Assessment of margins in transoral laser and robotic surgery.
abstract: The growing practice of endoscopic surgery has changed the therapeutic management of selected head and neck cancers. Although a negative surgical margin in resection of neoplasm is the most important surgical principle in oncologic surgery, controversies exist regarding assessment and interpretation of the status of margin resection. The aim of this review was to summarize the literature considering the assessment and feasibility of negative margins in transoral laser microsurgery (TLM) and transoral robotic surgery (TORS). Free margin status is being approached differently in vocal cord cancer (1-2 mm) compared with other sites in the upper aerodigestive tract (2-5 mm). Exposure, orientation of the pathological specimen, and co-operation with the pathologist are crucial principles needed to be followed in transoral surgery. Piecemeal resection to better expose deep tumor involvement and biopsies taken from surgical margins surrounding site of resection can improve margin assessment. High rates of negative surgical margins can be achieved with TLM and TORS. Adjuvant treatment decision should take into consideration also the surgeon's judgment with regard to the completeness of tumor resection.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Hamzany
authors.affiliation: Department of Otorhinolaryngology-Head Neck Surgery, Université Paris Descartes, Sorbonne Paris Cité, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brasnu
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and.
authors.forename: Thomas
authors.initials: T
authors.lastname: Shpitzer
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and.
authors.forename: Jacob
authors.initials: J
authors.lastname: Shvero
keywords: Cancer; glottis; laser; margin; robot; transoral