Skip to main content
SpringerLink
Log in

Transoral Microsurgery for Treatment of Laryngeal and Pharyngeal Cancers

  • Head and Neck Cancers (EY Hanna, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Minimally invasive surgery has evolved over the last two decades to encompass all fields of surgery, including curative intent cancer surgery of the head and neck. Much evidence is in favor of routine use of transoral laser resection, which can be considered the method of choice for treatment of early laryngeal carcinomas (T1–T2) of the glottis and the supraglottis on the basis of oncologic, functional, and cost considerations. The results of transoral laser microsurgery in patients with moderately advanced (T3) supraglottic cancer are comparable to those of open supraglottic laryngectomy with regard to local control and survival rates, and they are superior to those of primary radiotherapy with respect to organ preservation. Transoral laser microsurgery as a unique treatment should also be considered as an alternative to other organ preservation protocols in the early stages (I–II) of hypopharyngeal and oropharyngeal carcinomas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Karatzanis AD, Waldfahrer F, Psychogios G, et al. Resection margins and other prognostic factors regarding surgically treated glottic carcinomas. J Surg Oncol. 2010;101:131–6.

    PubMed  Google Scholar 

  2. Ansarin M, Santoro L, Cattaneo A, et al. Laser surgery for early glottic cancer: impact of margin status on local control and organ preservation. Arch Otolaryngol Head Neck Surg. 2009;135:385–90.

    Article  PubMed  Google Scholar 

  3. Blanch JL, Vilaseca I, Bernal-Sprekelsen M, et al. Prognostic significance of surgical margins in transoral CO(2) laser microsurgery for T1-T4 pharyngo-laryngeal cancers. Eur Arch Otorhinolaryngol. 2007;264:1045–51.

    Article  PubMed  Google Scholar 

  4. Jackel MC, Ambrosch P, Martin A, Steiner W. Impact of re-resection for inadequate margins on the prognosis of upper aerodigestive tract cancer treated by laser microsurgery. Laryngoscope. 2007;117:350–6.

    Article  PubMed  Google Scholar 

  5. Michel J, Fakhry N, Duflo S, et al. Prognostic value of the status of resection margins after endoscopic laser cordectomy for T1a glottic carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128:297–300.

    Article  PubMed  CAS  Google Scholar 

  6. Hartl DM, de Monès E, Hans S, et al. Treatment of early-stage glottic cancer by transoral laser resection. Ann Otol Rhinol Laryngol. 2007;116:832–6.

    PubMed  Google Scholar 

  7. Lucioni M, Marioni G, Bertolin A, et al. Glottic laser surgery: outcomes according to 2007 ELS classification. Eur Arch Otorhinolaryngol. 2011;268:1771–8.

    Article  PubMed  Google Scholar 

  8. Jeong WJ, Kim H, Ahn JC, et al. Serial endoscopic analysis of the glottis following laser cordectomy: from an oncological perspective. Lasers Med Sci. 2012;27:1025–31.

    Article  PubMed  Google Scholar 

  9. Just T, Lankenau E, Prall F, et al. Optical coherence tomography allows for the reliable identification of laryngeal epithelial dysplasia and for precise biopsy: a clinicopathological study of 61 patients undergoing microlaryngoscopy. Laryngoscope. 2010;120:1964–70.

    Article  PubMed  Google Scholar 

  10. Pogorzelski B, Hanenkamp U, Goetz M, et al. Systematic intraoperative application of confocal endomicroscopy for early detection and resection of squamous cell carcinoma of the head and neck: a preliminary report. Arch Otolaryngol Head Neck Surg. 2012;138:404–11.

    Article  PubMed  Google Scholar 

  11. Verma SP, Dailey SH. Overcoming nasal discomfort—a novel method for office-based laser surgery. Laryngoscope. 2011;121:2396–8.

    Article  PubMed  Google Scholar 

  12. • Peretti G, Piazza C, Cocco D, et al. Transoral CO(2) laser treatment for T(is)-T(3) glottic cancer: the University of Brescia experience on 595 patients. Head Neck. 2010;32:977–83. This provides a clear presentation of results by T stage in an important series.

    Article  PubMed  Google Scholar 

  13. Vilaseca I, Bernal-Sprekelsen M, Blanch JL. Transoral laser microsurgery for T3 laryngeal tumors: Prognostic factors. Head Neck. 2010;32:929–38.

    PubMed  Google Scholar 

  14. López-Álvarez F, Rodrigo JP, Llorente-Pendás JL, Suárez-Nieto C. Transoral laser microsurgery in advanced carcinomas of larynx and pharynx. Acta Otorrinolaringol Esp. 2011;62:95–102.

    Article  PubMed  Google Scholar 

  15. Blanch JL, Vilaseca I, Caballero M, et al. Outcome of transoral laser microsurgery for T2-T3 tumors growing in the laryngeal anterior commissure. Head Neck. 2011;33:1252–9.

    Article  PubMed  Google Scholar 

  16. Olthoff A, Ewen A, Wolff HA, et al. Organ function and quality of life after transoral laser microsurgery and adjuvant radiotherapy for locally advanced laryngeal cancer. Strahlenther Onkol. 2009;185:303–9.

    Article  PubMed  Google Scholar 

  17. Hinni ML, Salassa JR, Grant DG, et al. Transoral laser microsurgery for advanced laryngeal cancer. Arch Otolaryngol Head Neck Surg. 2007;133:1198–204.

    Article  PubMed  Google Scholar 

  18. Roedel RM, Matthias C, Wolff HA, et al. Transoral laser microsurgery for recurrence after primary radiotherapy of early glottic cancer. Auris Nasus Larynx. 2010;37:474–81.

    Article  PubMed  Google Scholar 

  19. Han YJ, Lee HS, Kim SW, et al. Transoral laser microsurgery of recurrent early glottic cancer after radiation therapy: clinical feasibility and limitations. Ann Otol Rhinol Laryngol. 2012;121:375–82.

    PubMed  Google Scholar 

  20. Schrijvers ML, van Riel EL, Langendijk JA, et al. Higher laryngeal preservation rate after CO2 laser surgery compared with radiotherapy in T1a glottic laryngeal carcinoma. Head Neck. 2009;31:759–64.

    Article  PubMed  Google Scholar 

  21. • Higgins KM, Shah MD, Ogaick MJ, Enepekides D. Treatment of early-stage glottic cancer: meta-analysis comparison of laser excision versus radiotherapy. J Otolaryngol Head Neck Surg. 2009;38:603–12. This is as meta-analysis of oncologic and functional outcomes.

    PubMed  Google Scholar 

  22. Feng Y, Wang B, Wen S. Laser surgery versus radiotherapy for T1–N0 glottic cancer: a meta-analysis. ORL J Otorhinolaryngol Relat Spec. 2011;73:336–42.

    Article  PubMed  Google Scholar 

  23. Viani L, Stell PM, Dalby JE. Recurrence after radiotherapy for glottic carcinoma. Cancer. 1991;67:577–84.

    Article  PubMed  CAS  Google Scholar 

  24. Eckel HE. Endoscopic laser resection of supraglottic carcinoma. Otolaryngol Head Neck Surg. 1997;117:681–7.

    Article  PubMed  CAS  Google Scholar 

  25. Preuss SF, Cramer K, Klussmann JP, et al. Transoral laser surgery for laryngeal cancer: outcome, complications and prognostic factors in 275 patients. Eur J Surg Oncol. 2009;35:235–40.

    Article  PubMed  CAS  Google Scholar 

  26. Phillips TJ, Sader C, Brown T, et al. Transoral laser microsurgery versus radiation therapy for early glottic cancer in Canada: cost analysis. J Otolaryngol Head Neck Surg. 2009;38:619–23.

    PubMed  Google Scholar 

  27. •• Higgins KM. What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope. 2011;121:116–34. This is an extremely well conducted meta-analysis of costs and outcomes.

    Article  PubMed  Google Scholar 

  28. Merrot O, Bige V, Poupart M, et al. Comparison between external radiotherapy and laser microsurgery for the treatment of TisT1N0 glottic carcinoma: Clinical modelling and cost-minimization study from the French national health insurance payer's point of view. Rev Laryngol Otol Rhinol (Bord). 2010;131:257–62.

    CAS  Google Scholar 

  29. Sjögren EV, van Rossum MA, Langeveld TP, et al. Voice outcome in T1a midcord glottic carcinoma: laser surgery vs radiotherapy. Arch Otolaryngol Head Neck Surg. 2008;134:965–72.

    Article  PubMed  Google Scholar 

  30. Núñez Batalla F, Caminero Cueva MJ, Señaris González B, et al. Voice quality after endoscopic laser surgery and radiotherapy for early glottic cancer: objective measurements emphasizing the Voice Handicap Index. Eur Arch Otorhinolaryngol. 2008;265:543–8.

    Article  PubMed  Google Scholar 

  31. Osborn HA, Hu A, Venkatesan V, et al. Comparison of endoscopic laser resection versus radiation therapy for the treatment of early glottic carcinoma. J Otolaryngol Head Neck Surg. 2011;40:200–4.

    PubMed  Google Scholar 

  32. Dinapoli N, Parrilla C, Galli J, et al. Multidisciplinary approach in the treatment of T1 glottic cancer. The role of patient preference in a homogenous patient population. Strahlenther Onkol. 2010;186:607–13.

    Article  PubMed  Google Scholar 

  33. • Spielmann PM, Majumdar S, Morton RP. Quality of life and functional outcomes in the management of early glottis carcinoma: a systematic review of studies comparing radiotherapy and transoral laser microsurgery. Clin Otolaryngol. 2010;35:373–82. This is a comprehensive systematic review analyzing vocal outcomes.

    Article  PubMed  CAS  Google Scholar 

  34. Suárez C, Rodrigo JP, Silver CE, et al. Laser surgery for early to moderately advanced Glottic. Supraglottic and Hypopharyngeal Cancers. Head Neck. 2012;34:1028–35.

    Article  PubMed  Google Scholar 

  35. Rudert HH, Werner JA, Höft S. Transoral carbon dioxide laser resection of supraglottic carcinoma. Ann Otol Rhinol Laryngol. 1999;108:819–27.

    PubMed  CAS  Google Scholar 

  36. Ambrosch P, Kron M, Steiner W. Carbon dioxide laser microsurgery for early supraglottic carcinoma. Ann Otol Rhinol Laryngol. 1998;107:680–8.

    PubMed  CAS  Google Scholar 

  37. Motta G, Esposito E, Testa D, et al. CO2 laser treatment of supraglottic cancer. Head Neck. 2004;26:442–6.

    Article  PubMed  Google Scholar 

  38. González-Márquez R, Rodrigo JP, Llorente JL, et al. Transoral CO2 laser surgery for supraglottic cancer. Eur Arch Otorhinolaryngol. 2012;269:2081–6.

    Article  PubMed  Google Scholar 

  39. Cabanillas R, Rodrigo JP, Llorente JL, Suárez C. Oncologic outcomes of transoral laser surgery of supraglottic carcinoma compared with a transcervical approach. Head Neck. 2008;30:750–5.

    Article  PubMed  Google Scholar 

  40. Bussu F, Almadori G, De Corso E, et al. Endoscopic horizontal partial laryngectomy by CO(2) laser in the management of supraglottic squamous cell carcinoma. Head Neck. 2009;31:1196–206.

    Article  PubMed  Google Scholar 

  41. Roh JL, Kim DH, Park CI. Voice, swallowing and quality of life in patients after transoral laser surgery for supraglottic carcinoma. J Surg Oncol. 2008;98:184–9.

    Article  PubMed  Google Scholar 

  42. Cabanillas R, Rodrigo JP, Llorente JL, et al. Functional outcomes of transoral laser surgery of supraglottic carcinoma compared with a transcervical approach. Head Neck. 2004;26:653–9.

    Article  PubMed  Google Scholar 

  43. Peretti G, Piazza C, Cattaneo A, et al. Comparison of functional outcomes after endoscopic versus open-neck supraglottic laryngectomies. Ann Otol Rhinol Laryngol. 2006;115:827–32.

    PubMed  Google Scholar 

  44. Rodrigo JP, Suárez C, Silver CE, et al. Transoral laser surgery for supraglottic cancer. Head Neck. 2008;30:658–66.

    Article  PubMed  Google Scholar 

  45. Vilaseca I, Blanch JL, Bernal-Sprekelsen M. Transoral laser surgery for hypopharyngeal carcinomas. Curr Opin Otolaryngol Head Neck Surg. 2012;20:97–102.

    Article  PubMed  Google Scholar 

  46. Lefebvre JL. What is the role of primary surgery in the treatment of laryngeal and hypopharyngeal cancer? Hayes Martin lecture. Arch Otolaryngol Head Neck Surg. 2000;126:285–8.

    PubMed  CAS  Google Scholar 

  47. Rudert HH, Höft S. Transoral carbon-dioxide laser resection of hypopharyngeal carcinoma. Eur Arch Otorhinolaryngol. 2003;260:198–206.

    PubMed  Google Scholar 

  48. Kutter J, Lang F, Monnier P, Pasche P. Transoral laser surgery for pharyngeal and pharyngolaryngeal carcinomas. Arch Otolaryngol Head Neck Surg. 2007;133:139–44.

    Article  PubMed  Google Scholar 

  49. Karatzanis AD, Psychogios G, Waldfahrer F, et al. T1 and T2 hypopharyngeal cancer treatment with laser microsurgery. J Surg Oncol. 2010;102:27–33.

    Article  PubMed  Google Scholar 

  50. Vilaseca I, Blanch JL, Bernal-Sprekelsen M, Moragas M. CO2 laser surgery: a larynx preservation alternative for selected hypopharyngeal carcinomas. Head Neck. 2004;26:953–9.

    Article  PubMed  Google Scholar 

  51. Martin A, Jäckel MC, Christiansen H, et al. Organ preserving transoral laser microsurgery for cancer of the hypopharynx. Laryngoscope. 2008;118:398–402.

    Article  PubMed  Google Scholar 

  52. Parsons JT, Mendenhall WM, Stringer SP, et al. Squamous cell carcinoma of the oropharynx: surgery, radiation therapy, or both. Cancer. 2002;94:2967–80.

    Article  PubMed  Google Scholar 

  53. Eckel HE, Volling P, Pototschnig C, et al. Transoral laser resection with staged discontinuous neck dissection for oral cavity and oropharynx squamous cell carcinoma. Laryngoscope. 1995;105:53–60.

    Article  PubMed  CAS  Google Scholar 

  54. Steiner W, Fierek O, Ambrosch P, et al. Transoral laser microsurgery for squamous cell carcinoma of the base of the tongue. Arch Otolaryngol Head Neck Surg. 2003;129:36–43.

    Article  PubMed  Google Scholar 

  55. Grant DG, Salassa Jr, Hinni ML, et al. Carcinoma of the tongue base treated by transoral laser microsurgery, part one: untreated tumors, a prospective analysis of oncologic and functional outcomes. Laryngoscope 2006;116:2150–2155.

  56. Camp AA, Fundakowski C, Petruzzelli GJ, et al. Functional and oncologic results following transoral laser microsurgical excision of base of tongue carcinoma. Otolaryngol Head Neck Surg. 2009;141:66–9.

    Article  PubMed  Google Scholar 

  57. Henstrom DK, Moore EJ, Olsen KD, et al. Transoral resection for squamous cell carcinoma of the base of tongue. Arch Otolaryngol Head Neck Surg. 2009;135:1231–8.

    Article  PubMed  Google Scholar 

  58. Rich JT, Milov S, Lewis Jr JS, et al. Transoral laser microsurgery (TLM) +/- adjuvant therapy for advanced stage oropharyngeal cancer: outcomes and prognostic factors. Laryngoscope. 2009;119:1709–19.

    Article  PubMed  Google Scholar 

  59. • Haughey BH, Hinni ML, Salassa JR, et al. Transoral laser microsurgery as primary treatment for advanced-stage oropharyngeal cancer: a United States multicenter study. Head Neck. 2011;33:1683–94. This multicenter study demonstrated the feasibility of TLM as a valid alternative to chemoradiotherapy in advanced oropharyngeal carcinoma.

    Article  PubMed  Google Scholar 

  60. Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091–8.

    Article  PubMed  CAS  Google Scholar 

  61. Urba S, Wolf G, Eisbruch A, et al. Single-cycle induction chemotherapy selects patients with advanced laryngeal cancer for combined chemoradiation: a new treatment paradigm. J Clin Oncol. 2006;24:593–8.

    Article  PubMed  CAS  Google Scholar 

  62. León X, López M, García J, Quer M. Results of an organ conservation protocol in patients with locally advanced laryngeal tumours. Acta Otorrinolaringol Esp. 2009;60:176–85.

    Article  PubMed  Google Scholar 

  63. Pointreau Y, Garaud P, Chapet S, et al. Randomized trial of induction chemotherapy with cisplatin and 5-fluorouracil with or without docetaxel for larynx preservation. J Natl Cancer Inst. 2009;101:498–506.

    Article  PubMed  CAS  Google Scholar 

  64. Mendenhall WM, Amdur RJ, Morris CG, Hinerman RW. T1–N0 squamous cell carcinoma of the glottic larynx treated with radiation therapy. J Clin Oncol. 2001;19:4029–36.

    PubMed  CAS  Google Scholar 

  65. Chera BS, Amdur RJ, Morris CG, et al. T1N0 to T2N0 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy. Int J Radiat Oncol Biol Phys. 2010;78:461–6.

    Article  PubMed  Google Scholar 

  66. Warde P, O'Sullivan B, Bristow RG, et al. T1/T2 glottic cancer managed by external beam radiotherapy: the influence of pretreatment hemoglobin on local control. Int J Radiat Oncol Biol Phys. 1998;41:347–53.

    Article  PubMed  CAS  Google Scholar 

  67. Nakfoor BM, Spiro IJ, Wang CC, et al. Results of accelerated radiotherapy for supraglottic carcinoma: a Massachusetts General Hospital and Massachusetts Eye and Ear Infirmary experience. Head Neck. 1998;20:379–84.

    Article  PubMed  CAS  Google Scholar 

  68. Mahler V, Boysen M, Brøndbo K. Radiotherapy or CO(2) laser surgery as treatment of T(1a) glottic carcinoma? Eur Arch Otorhinolaryngol. 2010;267:743–50.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain

    Carlos Suárez & Juan P. Rodrigo

  2. Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain

    Carlos Suárez & Juan P. Rodrigo

Authors
  1. Carlos Suárez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juan P. Rodrigo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos Suárez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Suárez, C., Rodrigo, J.P. Transoral Microsurgery for Treatment of Laryngeal and Pharyngeal Cancers. Curr Oncol Rep 15, 134–141 (2013). https://doi.org/10.1007/s11912-012-0286-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-012-0286-0

Keywords

Search

Navigation