22,23 Their subsequent development would lead to an apparent local recurrence that is simply the expression of the natural history of pre-existing lesions. Special care should be taken in glottic cancer with involvement of the anterior commissure or deep surgical margin.

Several articles have reported on lower local control rate Inhibitors,research,lifescience,medical in glottic cancer when involvement of the anterior commissure was found.24–29 The difficulty in adequate exposure of the anterior commissure using conventional laryngoscope can contribute to this result, stressing the importance of fully exposing this site during TLM by the use of larger and better designed laryngoscopes and by resection of supraglottic tissue as necessary.28,30 Anatomic constraints and hampered visibility may limit the surgeon’s ability Inhibitors,research,lifescience,medical to achieve adequate deep surgical margins. Peretti et al.,19 who evaluated the impact of superficial and deep positive margins in 595 patients treated with TLM for glottic cancer, found low impact of superficial positive margins on local control compared to deep infiltration (93% versus 85%). Transection

of the tumor can give the Inhibitors,research,lifescience,medical surgeon a much better assessment of the depth dimension and clear visualization of the deep margin during surgery.31 In order to ameliorate margin assessment different techniques have been studied. Frozen Section One of the valuable techniques is intraoperative resection margin evaluation by using a frozen section analysis for biopsy taken from the cut border of tissue remaining in the patient. Remacle et al.32 found frozen section to be reliable with 95% of the results accurate and stressed the possibility Inhibitors,research,lifescience,medical immediately to enlarge cordectomy to

obtain clear margin. Fang et al.17 reported that the status of the initial frozen-section margin analysis is a robust predictor of survival. In patients who had involvement by malignancy of the initial resection margin on frozen section, there was a statically significant increased rate of recurrent disease within the first year regardless of eventually Inhibitors,research,lifescience,medical achieving clear margins during the initial surgery. When using frozen section, one has to be familiar with its drawbacks. The reliability of a margin verdict using small fragments taken from the cut border PD184352 (CI-1040) of tissue remaining in the patient depends on the surgeon’s precision and the pathologist’s experience. Insufficient biopsy material or biopsy taken in between neoplastic cells can produce false negative results. Postoperative or post-radiotherapy patients can have granulation tissue, inflammatory click here infiltrate, or post-irradiation cell changes, making diagnosis more difficult. Moreover, use of multiple frozen sections for margin control, after the tumor has been removed, has intrinsic discrepancy with the phonomicrosurgical approach to the treatment of vocal cord cancer.