Transoral Laser Microsurgery for Early Glottic Cancer

Abstract

Objectives. To assess the outcome of transoral laser-assisted microsurgery (TLM) with regards to local and distant tumour control, quality of voice and swallowing. Design. Retrospective review of patients with five-year follow-up period. Setting. Royal Derby Hospital Head and Neck Department. Participants. All patients undergoing TLM with a diagnosis of Tis, T1, or T2 glottic tumour following endoscopic biopsy. Main Outcome Measures. Speech, swallowing, cancer-free survival, laryngectomy-free survival, and mortality rate. Results. 22 patients were treated for early glottic carcinoma with TLM. The 5-year local control rate for T1 tumours is 89% and 56% for T2 tumours. The laryngectomy rate was 4.5%. The mortality rate from local and distant disease was 4.5% with an overall mortality rate of 22% from all causes. 40% of patients had normal voices and a further 45% had only mild or moderate voice change. At their last followup, no patients assessed had any difficulty swallowing relating to their treatment for glottic cancer. Conclusion. Transoral Endoscopic CO2 laser microsurgery is a valid technique for treating early glottic tumours.

The role of primary transoral laser microsurgery in laryngeal cancer: a retrospective study

“…Furthermore, we have not explored the functional outcomes of primary transoral laser microsurgery in this study. However, our institution has previously reported good voice and swallowing outcomes in early‐stage glottic cancer . Further analysis of the functional outcomes in late‐stage disease is needed.…”

Audit of transoral laser-assisted microsurgical resection of early laryngeal cancer

“…Our histological reporting also complied with the recommended standards for three-dimensional assessments, including the deep margin. However, other factors such as trauma from surgical instruments or tissue handling, artefacts from histopathological slide preparation and thermal damage from laser use can lead to difficulties in margin interpretation 14 , 15 . The deep margin could not be assessed with confidence in almost 10 per cent of our cases owing to thermal damage.…”

“…However, other factors such as trauma from surgical instruments or tissue handling, artefacts from histopathological slide preparation and thermal damage from laser use can lead to difficulties in margin interpretation. 14,15 The deep margin could not be assessed with confidence in almost 10 per cent of our cases owing to thermal damage. Makki et al reported a significantly higher degree of artefacts with transoral laser microsurgery compared with cold steel excision, which caused difficulty in assessing specimens; however, positive margins could still be confidently interpreted.…”

Role of lasers in glottic malignancies: our experience

“…45% of patients in this study had mild or moderate voice change. 15 The quality of voice after TLM depends on the degree of resection required and more superficial tumours have a better outcome. 15 In a study by Ahmed et al, the laryngeal preservation rate for patients who initially received KTP laser treatment was 46 out of 47 patients (98%).…”

“…15 The quality of voice after TLM depends on the degree of resection required and more superficial tumours have a better outcome. 15 In a study by Ahmed et al, the laryngeal preservation rate for patients who initially received KTP laser treatment was 46 out of 47 patients (98%). 1 Of the cohort who received primary radiation, the laryngeal preservation rate was 36 out of 40 patients (90%).…”