TLM Outcomes in Elderly Patients with Glottic Pre-Malignancy and Early Malignancy; A 12-Year Retrospective Study

Abstract

Introduction: UK population ageing and associated cancer risk predicts an increase in the prevalence of laryngeal cancer in elderly patients. Whilst trans-oral laser microsurgery (TLM) has been demonstrated to achieve excellent control of early disease with few complications, data specifically related to its safety and efficacy in older patients is lacking. We report the largest series to date. Objectives: To assess the safety and efficacy of TLM in elderly patients with glottic pre-malignancy and early malignancy. Methods: A retrospective review and statistical analysis of the clinical records of patients aged 70 or over undergoing TLM for early and premalignant glottic disease. Results: The records of 106 patients over the age of 70 were identified. Thirteen records were excluded, 4 due to failure to meet the inclusion criteria (stage I/II disease, primary site of lesion in the glottis) and 9 due to incomplete follow up data capture. Most surgeries (>70%) were performed as a day case or overnight admission, with only 2 admissions >2 days. One patient required hospital readmission with dysphagia, resulting in an altered diet. No patients required tracheostomy or tube feeding. No treatment related deaths or intensive care admissions were observed. Ten patients had recurrent disease within 5 years; 1 received radiotherapy, 1 underwent salvage laryngectomy, the remainder had further TLM without complication. Five-year disease specific survival rates were >90%. Conclusion: Our results demonstrate that TLM is safe and effective for elderly patients, with outcomes comparable to those reported in large, non-age selected cohorts. Although our patients underwent more conservative cordectomy types (I-III) than those with similar disease stages reported elsewhere, our recurrence rates were not higher. This supports the oncological effectiveness of surgery whilst reducing the risk of associated functional compromise.

Latin American Consensus on the Treatment of Head and Neck Cancer

“…Chronologic age alone should not determine treatment decisions, but it is essential to recognize that elderly patients often have more comorbidities and are at a higher risk of postoperative complications. [194][195][196][197][198][199][200][201][202][203][204][205] Nonsurgical treatments for laryngeal or hypopharyngeal SCC should be considered for patients who cannot undergo partial laryngectomy and those with stage T3 and lowvolume stage T4a tumors that still have a preservable larynx but are candidates for total laryngectomy. Total laryngectomy is recommended for cases involving laryngeal dysfunction, extensive infiltrative tumors with cartilage invasion and extralaryngeal spread, or when nonsurgical organ preservation treatments have failed.…”