Transoral CO2 laser microsurgery for early hypopharyngeal cancer: Still a viable option?

Introduction: Hypopharyngeal squamous cell carcinoma (HPSCC) is a highly aggressive malignancy with poor prognosis due to late-stage diagnosis and complex anatomical challenges. Advances in minimally invasive techniques, particularly transoral laser microsurgery (CO₂TOLMS), have demonstrated promise in improving oncologic and functional outcomes while preserving organ function.

Materials and methods: A retrospective study analyzed 25 patients with histologically confirmed HPSCC treated with CO₂TOLMS at a tertiary academic hospital (2016-2021). Patients underwent curative-intent CO₂TOLMS, with outcomes assessed for survival, recurrence, and functional recovery.

Results: The 3-year overall survival and disease-specific survival rates were 72% and 84%, respectively. Surgical margins were disease-free in 76% of patients, while postoperative complications were minimal (persistent tracheostomy in 4%, long-term nasogastric feeding tube dependency in 4%). Local and regional recurrence rates were each 8%. Laryngeal preservation was achieved in 95% of cases, significantly enhancing quality of life. Histologic grade correlated with recurrence risk, though survival outcomes were consistent across tumor stages and surgical margin status.

Conclusions: CO₂TOLMS offers an effective and minimally invasive treatment for early-stage HPSCC, achieving good oncological and functional outcomes. While it provides low morbidity and high organ preservation rates, further research is needed to refine multimodal treatment strategies for advanced-stage disease.