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The aim of this study was to evaluate the practices of ENT surgeons for the management of surgical margins after endoscopic laser surgery for early glottic cancers. A questionnaire was sent to different surgeons managing cancers of the larynx in France, Belgium and Switzerland. A descriptive and comparative analysis of practices across centers was performed. Sixty-nine surgeons completed the questionnaire (58 in France, 10 in Belgium and 1 in Switzerland). In case of very close or equivocal resection margins after definitive histological examination, 67 % of surgeons perform close follow-up, 28 % further treatment and 5 % had no opinion. Factors resulting in a significant change in the management of equivocal or very close margins were: the country of origin (p = 0.011), the specialty of the multidisciplinary team leader (p = 0.001), the fact that radiation equipment is located in the same center (p = 0.027) and the access to IMRT technique (p = 0.027). In case of positive resection margins, 80 % of surgeons perform further treatment, 15 % surveillance, and 5 % had no opinion. The only factor resulting in a significant change in the management of positive margins was the number of cancers of the larynx treated per year (p = 0.011). It is important to spare, on one hand equivocal or very close margins and on the other hand, positive margins. Postoperative management should be discussed depending on intraoperative findings, patient, practices of multidisciplinary team, and surgeon experience. This management remains non-consensual and writing a good practice guideline could be useful.

The aim of this study was to evaluate the practices of ENT surgeons for the management of early glottic cancers affecting only one vocal cord, i.e. classified T1a. A questionnaire was sent to different surgeons managing cancers of the larynx in France, Belgium and Switzerland. A descriptive and comparative analysis of practices across centers was performed. The decision-making parameters of the therapeutic strategy were analyzed. Sixty-nine surgeons completed the questionnaire (58 in France, 10 in Belgium and one in Switzerland). In the example of a 50-year-old man with active tobacco use and no oncologic history presenting a squamous cell carcinoma of the middle third of the vocal cord classified T1aN0M0, and with easy glottic exposition by laryngoscopy, 91 % of surgeons proposed endoscopic surgery laser, 2 % radiotherapy and 7 % proposed one of these two treatments without any preference. Therapeutic strategies were not influenced by the sex (p = 1.00), the smoking status (p = 0.58) or the age of the patient (more or less than 80 years, p = 0.27). A significant change was observed in the therapeutic strategy for tumors non-exposable by laryngoscopy (p = 0.032), tumors reaching the anterior commissure (p = 0.001) and patients using their voice professionally (p = 0.0003). The management strategy of T1a glottic carcinomas, in our series, is mainly surgical. The choice of therapeutic strategy seems to be based, in our series, on criteria such as the risk of a second location, cost, and duration of treatment.