Oncological Outcome of Transoral Laser Surgery in Laryngeal Carcinomas

The principles of treatment of laryngeal carcinoma have undergone changes over the last few years and can be very complex with early(I-II) and advanced (III-IV) stage diseases to be differentiated. Recent emphasis is on organ preservation and laryngeal function.Transoral CO2 laser surgery has become a standard surgical procedure not only in early stage I and II laryngeal carcinomas but also inadvanced stage III cases in combination with postoperative adjuvante radiochemotherapy. This retrospective study reflects the role oftransoral laser surgery as a single or multimodality treatment regime with neck dissection and postoperative radiochemotherapy inlaryngeal carcinomas.From January 1997 to February 2007, 239 patients (215 men and 24 women; mean age 61 years) were examined with laryngealsquamous cell carcinoma (stage I-IV). 220 out of these 239 patients underwent transoral laser surgery, depending on their tumor stageeither as a single or as a multimodality treatment regimen in combination with bilateral neck dissection and postoperative radio-chemotherapy.Thirteen patients underwent a transcervical tumor resection, 5 patients underwent radiochemotherapy alone and one patient refused atreatment of his tumor disease. Median follow-up time was 60 months.The 5-year overall survival rate of the 220 patients who were treated with laser surgery was 86%. The 5-year recurrence-free survivalrate was 69.5%. After laser surgical interventions, postoperative complications occurred in 16%.The oncological outcome of transoral laser surgery as a single mode in early laryngeal carcinomas or in combination with bilateral neckdissection and postoperative adjuvant radiochemotherapy in advanced tumor stages is satisfying if clean surgical tumor margins (R0) canbe reached. If tumor-free margins cannot be achieved (R1 and R2 resection) and transoral revision is not possible, transcervicalprocedures (total or partial laryngectomy) must be considered.