CO(2) laser versus cold steel margin analysis following endoscopic excision of glottic cancer

OBJECTIVE: To compare the suitability of CO(2) laser with steel instruments for margin excision in transoral laser microsurgery. METHODS: Prospective randomized blinded study. Patients with glottic cancer undergoing laser resection were randomized to margin excision by either steel instruments or CO(2) laser. Margins were analyzed for size, interpretability and degree of artifact by a pathologist who was blinded to technique. RESULTS: 45 patients were enrolled in the study with 226 total margins taken. 39 margins taken by laser had marked artifact and 0 were uninterpretable. 20 margins taken by steel instruments had marked artifact, and 2 were uninterpretable. Controlling for margin size, the laser technique was associated with increasing degrees of margin artifact (p = 0.210), but there was no difference in crude rates of uninterpretability (p = 0.24). CONCLUSION: Laser margin excision is associated with a greater degree of artifact than steel instrument excision, but was not associated with higher rate of uninterpretability.