Systematic review and meta‐analysis of transoral laser microsurgery in hypopharyngeal carcinoma

Abstract

Background Transoral laser microsurgery has been suggested as an alternative treatment modality for hypopharyngeal carcinoma. The purpose of this study is to systematically review the oncologic and functional outcomes of patients with hypopharyngeal carcinoma when treated with primary transoral laser microsurgery. Methods A comprehensive literature search was performed using PRISMA methodology on OVID MEDLINE and EMBASE. Meta‐analysis was completed for oncological outcomes. Results Six studies reported quality of life outcomes five reported oncologic outcomes. A median of 95% (range 0.83‐0.98) patients achieving gastrostomy independence, a median of 3% (range 0%‐6%) were tracheostomy dependent, and a median of 97% (Range 0.89‐1.0) were able to preserve their larynx. Pooled five‐year overall survival was 54% (CI, 0.50‐0.58, I2 = 29%), pooled disease‐specific survival was 72% (CI, 0.68‐0.77, I2 = 46%), and pooled local control rate was 78% (CI, 0.72‐0.85, I2 = 69%). Conclusion Systematic review supports improvements in functional outcomes and oncologic outcomes with transoral laser microsurgery.

Oncological and functional outcomes of transoral laser surgery for hypopharyngeal carcinoma

“…We obtained an excellent LCR of 92% at 5 years, superior to the rates described in the other studies (Table 4 ) and the 78% pooled local control rate described in the meta-analysis of Lane [ 2 ]. Our better LCR could be explained, because we only included tumors classified T1 and T2, whereas the other reports about TOLMS (except the one from Karatzanis et al [ 19 ]) also included a variable proportion of tumors classified T3 and T4 (6.9–62%).…”

“…In this regard, only one of our patients required a temporary gastrostomy and two a tracheostomy, but in all of them they could be removed. In contrast, in the review from Lane et al [ 2 ], gastrostomy rates ranged from 2.2 to 17%, with a median of 95% patients achieving oral intake, while tracheostomy rates ranged from 0 to 6% (median 3%). These results compare well with functional reports of other treatments in HPSCC.…”

“…TOLMS as treatment for T1-T2 HPSCC has achieved excellent outcomes, such as those obtained with open surgical procedures and RT, with lower postoperative morbidity and optimal functional results [ 1 , 3 , 8 , 9 ]. A recent meta-analysis has shown that there were no significant differences between TOLMS and RT for local control and for OS in early staged tumors, and suggests improvements in functional and oncological outcomes with TOLMS [ 2 ]. However, due to the scarcity of works on the subject, only 6 articles could be included in this meta-analysis, most of them with a small number of patients (only two of them had 50 patients or more), so the results should be interpreted with caution.…”

Transpharyngeal Approaches for Management of Oropharyngeal Squamous Cell Carcinoma: Mayo Clinic Institution Experience

“…In terms of functional outcomes, PEG and tracheostomy tube dependence 33 have become hallmark tools to quantify the functional sequelae of treatment regimens when more detailed data are unavailable. [34][35][36] Long-term tracheostomy dependence greatly affects a patient's overall quality of life. 37,38 The tracheostomy dependence rate was 4.5% in our cohort and ranged from 0% to 5% in the literature.…”

Research Article Use of transoral CO2 laser microsurgery for treatment of cancerous neoplasms of the larynx in Vietnam

“…The TLM method, especially at stages T1 or T2, shows some of the best results (Mehanna et al, 2016), and application of the CO2 lasers for laser transoral resection of laryngeal cancer is the gold standard (Strieth et al, 2020). In particular, the transoral laser microsurgical technique offers a beneficial alternative to primary chemotherapy (Lane et al, 2020).…”