Background: Resection margins are an important prognostic factor for patients with head and neck cancer. In general, for head and neck surgery, a margin >5 mm is advised by the Royal College of Pathologists. However, this cannot always be achieved during laryngeal and hypopharyngeal surgery. The aim of this study is to identify the resection surfaces and measure the maximum feasible margins per subsite. The clinical relevance of these maximum feasible resection margins were analyzed in this descriptive anatomical study. Methods: head and neck surgeons and a pathologist from the Erasmus MC performed a total laryngectomy and laryngopharyngectomy on a head and neck specimen specifically available for research. Results: For a total laryngectomy, resection margins >5 mm were not feasible for the ventral and dorsal resection surface. For a total laryngopharyngectomy, resection margins >5 mm were not feasible for the ventral, dorsal and lateral resection surface. Conclusion: Clear resection margins, defined as a margin >5 mm, are not always feasible in laryngeal and hypopharyngeal surgery, due to the anatomy of the larynx and tumor location. However, striving for a maximum feasible margin is still the main goal. We propose a new guideline for maximum feasible but adequate resection margins in larynx and hypopharynx tumor surgery.
背景：手术切缘是头颈癌患者的重要预后因素。通常，英国皇家病理学家学会建议头颈外科手术的切缘应大于5毫米。然而，在喉部和下咽部手术中，这一标准往往难以实现。本研究旨在识别喉部和下咽部各亚区的切除面，并测量各部位可达到的最大切缘。通过这项描述性解剖研究，分析了这些最大可行切缘的临床意义。方法：来自伊拉斯姆斯医学中心的头颈外科医生和病理学家，利用专门用于研究的头颈标本，进行了全喉切除术和喉咽切除术。结果：在全喉切除术中，腹侧和背侧切除面无法实现大于5毫米的切缘。在全喉咽切除术中，腹侧、背侧和外侧切除面均无法实现大于5毫米的切缘。结论：由于喉部解剖结构和肿瘤位置的影响，在喉部和下咽部手术中，达到大于5毫米的清晰切缘并非总是可行。然而，争取最大可行切缘仍是主要目标。我们为喉部和下咽部肿瘤手术提出了一项新的指导原则，旨在实现最大可行且适当的切除范围。
肿瘤(癌症)患者之家