title: Management of surgical margins after endoscopic laser surgery for early glottic cancers: a multicentric evaluation in French-speaking European countries.
abstract: The aim of this study was to evaluate the practices of ENT surgeons for the management of surgical margins after endoscopic laser surgery for early glottic cancers. A questionnaire was sent to different surgeons managing cancers of the larynx in France, Belgium and Switzerland. A descriptive and comparative analysis of practices across centers was performed. Sixty-nine surgeons completed the questionnaire (58 in France, 10 in Belgium and 1 in Switzerland). In case of very close or equivocal resection margins after definitive histological examination, 67 % of surgeons perform close follow-up, 28 % further treatment and 5 % had no opinion. Factors resulting in a significant change in the management of equivocal or very close margins were: the country of origin (p = 0.011), the specialty of the multidisciplinary team leader (p = 0.001), the fact that radiation equipment is located in the same center (p = 0.027) and the access to IMRT technique (p = 0.027). In case of positive resection margins, 80 % of surgeons perform further treatment, 15 % surveillance, and 5 % had no opinion. The only factor resulting in a significant change in the management of positive margins was the number of cancers of the larynx treated per year (p = 0.011). It is important to spare, on one hand equivocal or very close margins and on the other hand, positive margins. Postoperative management should be discussed depending on intraoperative findings, patient, practices of multidisciplinary team, and surgeon experience. This management remains non-consensual and writing a good practice guideline could be useful.
authors: Service d'ORL et Chirurgie Cervico-Faciale, Assistance Publique-Hôpitaux de Marseille (AP-HM), Aix-Marseille Université, Centre Hospitalier Universitaire (CHU) la Timone, 264 rue Saint Pierre, 13385, Marseille Cedex 05, France, nicolas.fakhry@ap-hm.fr.
authors: Nicolas
authors: N
authors: Fakhry
authors: Sébastien
authors: S
authors: Vergez
authors: Emmanuel
authors: E
authors: Babin
authors: Karine
authors: K
authors: Baumstarck
authors: Laure
authors: L
authors: Santini
authors: Patrick
authors: P
authors: Dessi
authors: Antoine
authors: A
authors: Giovanni
mesh_terms: D001291:Attitude of Health Personnel; D001530:Belgium; D019468:Disease Management; D005602:France; D005931:Glottis / Q000473:pathology*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007828:Laryngoscopy / Q000009:adverse effects / Q000379:methods; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D011184:Postoperative Period; D011795:Surveys and Questionnaires; D013557:Switzerland