Roh et al.24 have evaluated the efficacy of second-look laryngoscopy in patients with glottic cancer involving the anterior commissure. They concluded that it is unclear whether routine second-look laryngoscopy is necessary

in detecting tumor recurrence and suggested that it should be performed at a time later than 3 months after first surgery. Preuss et al.33 stressed the efficiency of a second-look procedure in Inhibitors,research,lifescience,medical detection of recurrent disease at a very early stage, also suggesting that the interval between the first surgery and the second-look laryngoscopy should be longer than 10 weeks. The benefits of a routine practice of second-look laryngoscopy should be evaluated against the additional stress, risks, and high cost of surgery with general anesthesia.32 Optical and Molecular Techniques Over the past two decades several optical imaging technologies have been used in the operating room in order to improve the ability to identify tumor margin in vivo and in situ to guide surgical Inhibitors,research,lifescience,medical excision. This concept is particularly important for lesions on the vocal cords where conservation of the delicate superficial Inhibitors,research,lifescience,medical lamina propria is crucial for preservation of voice quality. Andrea et al. were the first to use contact endoscopy in the diagnosis of laryngeal disease in 1995.34

By using a magnifying endoscope placed Inhibitors,research,lifescience,medical in direct contact with the mucosal surface, images at ×60 or ×150 magnification of the superficial layers of the vocal cord epithelium are obtained.35 In the diagnosis of malignant lesions sensitivity and specificity rates of 80% and 100%, respectively, have been reported.36 An important limitation of contact endoscopy is its inability to give clear images of cells NVP-AEW541 concentration beyond the most superficial Inhibitors,research,lifescience,medical layers of the epithelium, meaning the basement membrane; therefore

distinction between cis and invasive carcinoma is prevented.37 Hughes et al. reviewed the efficacy of different optical and molecular techniques to identify tumor margins within the larynx.37 They conclude that further research and randomized clinical trials are required to validate these techniques and establish their benefit to patients. ASSESSMENT OF MARGINS IN ENDOSCOPIC SURGERY—NON-GLOTTIC however CANCER For external approaches, recommendations regarding safety margins in the oropharynx, hypopharynx, and supraglottic most commonly range from 5 mm to a few centimeters, depending on tumor site and surgeon. TLM aims to preserve as much healthy tissue as possible in order for function to be maintained and to enable early recovery, and although wider free margins than in the vocal cords are commonly accepted, a large distance as in external approach is uncommon.