The real prognostic role of laryngeal dysplasia in patients affected by invasive cancer

Abstract

Purpose

Transoral laser microsurgery is the mainstay in treating early-stage laryngeal squamous cell carcinoma. However, consensus is lacking in non-radical surgery for infiltrating cancer, and even doubts are cast for patients with laryngeal dysplasia at the resection margins. In this study we aim to assess the prognostic significance of laryngeal dysplasia at the surgical margins in patients radically treated for infiltrating cancer.

Materials and methods

Patients treated between 2000 and 2020 for infiltrating cancer were included. We selected patients whose final histopathological report confirmed radical excision for infiltrating cancer. The cohort was further divided into two subgroups according to the presence or the absence of dysplastic resection margins. All patients underwent follow up to assess oncological outcomes, and the results from the two subgroups were compared to assess the prognostic relevance of laryngeal dysplasia.

Results

A cohort of 281 patients was evaluated. From the statistical analysis, the supraglottic extension of infiltrating cancer and deep muscle infiltration were associated worse oncological outcomes. Conversely, the presence of critical dysplastic margins, dysplastic severity and the number of positive margins were not linked to worse outcomes.

Conclusion

In our experience, the presence of dysplasia at the resection margins does not affect patient survival. Thus, revision surgery for critical dysplastic margins, following radical excision of infiltrating carcinoma should not be performed. Instead, patients may undergo endoscopic monitoring, thereby avoiding unnecessary overtreatment and potential negative effects on voice outcomes.