transoral laser surgery for supraglottic squamous cancers

Objective: The objective of the study was to evaluate the oncological and functional results of transoral CO2laser microsurgery (TLM). Study Design: This is a retrospective study of squamous cancers of the supraglottis treated with transoral CO2laser resection. Materials and Methods: Between May 1997 and April 2014, 131 cases of T1/T2/T3squamous cancer of the supraglottis/hypopharynx with freely mobile vocal cords and no gross invasion of the laryngeal spaces, were resected transorally with the CO2laser. Results: Oncologically, resections performed under the magnification of the operating microscope are safe and yield high local control rates ranging from 79% to 85% for supraglottic cancer. For salvage of local recurrences following TLM, a full range of treatment options remains available including re-use of TLM. Of the 29 recurrences, 9 were salvaged with repeat TLM, 4 with radiotherapy, and 6 with total laryngectomy. In supraglottic cancer, management of neck is very important. Twenty patients with the clinically “N+” neck at presentation, underwent neck dissection at the same time of TLM or after an interval of 4–5 days. For the 111 “N0” cases, the neck was treated only if and when metastasis manifested at followup. Thus, nine patients underwent neck dissection for regional recurrence at followup. The neck was also treated in the local/locoregional recurrences salvaged either with radiotherapy or total laryngectomy. There were two cases of advanced regional recurrences that could only be offered palliative care.