Three Dimensional Study Of Surgical Margin In Laryngeal Carcinoma

Objective:Laryngeal carcinoma(LC) is a frequent malignant tumor in department of otolaryngology.Surgical operation is the most important method for the treatment of laryngeal carcinoma.For the irregularity of LC region and infiltrating in three dimensions,the completed and safety excision of LC requests us to grasp the mucous margin and infiltrating of submucous and fundament.Residence of carcinoma cell in surgical margin can lead to the failure of operation and local recurrence.Definiting the surgical margin sciencely is the nuclear factor for survival rate and laryng-function reservation after operation.In this topic,we study the surgical margin in three dimensions by ways of histothology and biology.After comprehending the infiltrating character of LC in three dimensions,we can provide some guidance for the treatment of LC.Methods:The specimens acquired from laryngeal cancer and adjacent tissue at the site of 0.5cm,1cm and 2cm were detected by approaches of flow cytometry to get DNA index.By ways of immunohisto-chemistry we detect the expression of PCNA and matrix metalloproteinase-2(MMP-2) in laryngeal cancer and the adjacent tissue of cancer.Cases with LC were vertically cut-down along tumor long axis,and were slivered into sections by which laryngeal carcinoma sub mucosal infiltrating distance was measured under microscope. Laryngeal carcinoma latent sub mucosal infiltrating extend was compared among different location,different T staging and external appearance.Specimens were performed with pathology observation and study of CK-19 expression.Results:1.The difference of DNA content and expression of PCNA in laryngeal carcinoma and the tissue at the site of 0.5 cm,1cm,2cm away from laryngeal carcinoma was significant.2.There was significant difference of matrix metalloproteinase-2 expression between laryngeal carcinoma and the tissue at the site of 0.5cm,1cm away from laryngeal cancer.3.The values of laryngeal carcinoma sub mucosal infiltrating distance with different location, T staging and external appearance were different.There was no significant difference between glottic carcinoma and supraglottic carcinoma,yet there was significant difference between T_1/2 and T_3/4 laryngeal carcinoma.In exogenic type,ulcerating infiltrating type and mixed infiltrating type,there was significant differences between the first and the second type,and between the first and the third type,no significant difference between the first and the third type.4.There was correlation between the expression of CK-19 at deepness surgical margin and T staging,also for the primary localization and the expression of CK- 19.Conclusions:1.The index inflecting the proliferating and infiltrating of laryngeal carcinoma cell turned gradually into normal level from laryngeal cancer tissue to the normal tissue.According to this regularity,0.5cm away from laryngeal cancer periphery may be determined as basic safe surgical margin,and 1.0cm may be determined as satisfactory safe surgical margin.2.As laryngeal carcinoma T stage developing,tumor submucosal infiltrating extent is becoming more extensive.Laryngeal carcinoma submucosal infiltrating extents with ulcerating infiltrating and mixed infiltrating type are more extensive than exogenic type.The cases with local advanced ulcerating infiltrating and mixed infiltrating laryngeal carcinoma should be prudent to be performed by partial laryngectomy.3.Different staging,different the deepness surgical margin of laryngeal cancer.Expression of CK-19 was negative in the extremital tissue of laryngeal cancer fundament,such as muscular tissue,connective tissue and cartilage tissue.They were also anatomic landmark of LC operation and barricade of LC invasive.