Transoral laser microsurgery for advanced laryngeal cancer

OBJECTIVE: To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of advanced laryngeal cancer. DESIGN: Prospective case series study. SETTING: Multi-institution (academic, tertiary referral centers). PATIENTS: A total of 117 patients with pathologically confirmed T2 to T4 lesions, stage III or stage IV, glottic or supraglottic carcinoma of the larynx were treated with TLM from 1997 to 2004. All patients had a minimum follow-up period of 2 years. INTERVENTIONS: Transoral laser microsurgery in 117 patients, neck dissection in 91 patients, and adjuvant radiotherapy in 45 patients. MAIN OUTCOME MEASURES: End points analyzed included laryngeal preservation, overall survival, disease-free survival, local control, locoregional control, and distant metastases. Postoperative complications, tracheotomy rate, and feeding-tube dependence were also examined. RESULTS: The median follow-up period among surviving patients was 5 years. At 2 years, the percentage of patients with an intact larynx after treatment was 92%. The 2-year local control and locoregional control rates were 82% and 77%, respectively. The 2-year disease-free and overall survival rates were 68% and 75%, respectively. The 5-year Kaplan-Meier estimates were local control, 74%; locoregional, control, 68%; disease-free survival, 58%; overall survival, 55%; and distant metastases, 14%. Four patients (3%) experienced treatment-related deaths. Seven patients (6%) experienced a postoperative hemorrhage. Of those patients with organ preservation and no disease recurrence, 2 patients (3%) were tracheotomy dependent, and 4 patients (7%) were feeding-tube dependent. CONCLUSIONS: In patients with advanced laryngeal cancer, TLM with or without radiotherapy is a valid treatment strategy for organ preservation. Furthermore, low morbidity and mortality and excellent oncologic and functional outcomes make TLM an attractive therapeutic option.