Functional Outcomes after Salvage Transoral Laser Microsurgery for Laryngeal Squamous Cell Carcinoma

Abstract

TLM is a successful surgical option for recurrent laryngeal cancer with acceptable functional outcomes.

Salvage Transoral Laser Microsurgery for Radiorecurrent Laryngeal Cancer: Indications, Limits, and Outcomes

“…The series of Puxeddu et al [15] is a two-center retrospective case series, with results of one included center updated in a later publication by Piazza et al [16], which, in turn, was updated by Del Bon et al [17]. Most authors reported on series of rT1 to rT2 glottic cancer, while some authors also included more advanced glottic cases (rT3 or even rT4) [11••, 18–21] or supraglottic recurrences [14, 18, 20–22]. …”

“…Tracheotomy was not required as a routine procedure (in contrast to open partial laryngeal surgery) with most studies reporting a 0% tracheotomy rate. However, in four series [11••, 20, 21, 24], postoperative tracheotomy proved necessary in 2 to 22% of cases, with decannulation times ranging from 4 days to more than 4 months. The nasogastric tube feeding rate ranged from 0 to 23.5% with all nasogastric tubes being removed after 8 days.…”

“…The nasogastric tube feeding rate ranged from 0 to 23.5% with all nasogastric tubes being removed after 8 days. Three studies reported cases in which long-term gastrostomy tube (G-tube) feeding was required [19–21]. However, two of these studies, in which both glottic and supraglottic recurrences were included, reported—as expected—higher G-tube dependency in the supraglottic recurrences when compared to the glottic cancer recurrences (60 versus 20% [20] and 79 versus 21% [21]).…”

“…Three studies reported cases in which long-term gastrostomy tube (G-tube) feeding was required [19–21]. However, two of these studies, in which both glottic and supraglottic recurrences were included, reported—as expected—higher G-tube dependency in the supraglottic recurrences when compared to the glottic cancer recurrences (60 versus 20% [20] and 79 versus 21% [21]). When all patients of the included studies were taken into account ( n  = 350), postoperative tracheotomy need and G-tube requirement were only 2.3% ( n  = 8) and 6.6% ( n  = 23), respectively.…”

“…Laryngostroboscopy showed an incomplete glottal closure in 56% of patients [15]. Fink et al observed a significant increase in mean voice handicap index (VHI) (from 31.8 preoperatively to 53.5 postoperatively, p  = 0.026) and decrease in perceptual score (from 57.0 to 45.3, p  = 0.017) in patients who underwent salvage TLM for glottic recurrences [21]. Of interest is the functional analysis by Del Bon et al, who retrospectively compared 10 salvage TLM patients with 10 patients treated by primary TLM, after matching for age, gender, and pT category.…”