Transoral resection of supraglottic tumours using microelectrodes (54 cases)

We present the oncological and functional results of surgical transoral resection of supraglottic laryngeal carcinomas using microelectrodes. This prospective multicentre trial was conducted from 2005 to 2009. It included 54 patients (23 T1, 14 T2, and 17 T3) with supraglottic cancer, with a follow-up of 2 years. Outcome measurements were: tracheostomy, hospital stay, nasogastric feeding and recurrences. Four patients required permanent tracheostomies. The mean hospital stay was 8.1 days. Temporary nasogastric feeding was necessary in 13 patients. Postoperative complications included two incidences of haemorrhage requiring surgical intervention and one pneumonia. Four patients out of eight with T3 tumours had regional recurrence; in these cases salvage surgery was performed: two cases by the transoral approach and six total laryngectomies. Clinical results were similar to those obtained with CO₂ laser therapy. We list other advantages of the technique and include a literature review.     

CO2激光手术治疗声门上型喉癌

目的 总结CO2激光手术治疗声门上型喉癌的临床治疗效果.方法 回顾性分析1995年2月至2005年6月CO2激光手术治疗的32例声门上型喉癌患者临床资料.32例患者中T1N0M0 20例,T1N1M0 2例,T2N0M0 8例,T2N1M0 2例,全部病例术后随诊3年以上.喉部肿瘤均经口行激光手术,同期行择区性(Ⅱ-Ⅳ区)颈清扫术12例,改良全颈清扫术4例.结果 KaplanMeier法统计5年生存率为90.6%,其中T1病变5年生存率为95.6%,T2病变为78.2%.喉的局部控制率为96.8%;喉局部和颈部区域5年控制率为90.3%,其中T1病变5年局部区域控制率为90.9%,T2病变为89.0%.喉部局部复发2例,1例再治疗行喉水平垂直部分切除术,1例行喉全切除术.颈部区域复发2例,其中1例喉部复发伴颈淋巴转移,再治疗后存活;1例颈部复发,治疗后再次颈部复发并伴肺转移死亡.4例患者出现较轻并发症,保守治疗后好转.除1例患者因局部复发行喉全切除外,其余存活患者喉功能良好.结论 激光治疗早期声门上型喉癌创伤小、疗效可靠,是一种理想的治疗方式.     

Occult metastases from T1–T2 supraglottic carcinoma: role of primary tumor localization

The present study was undertaken to evaluate the role of localization on the rate of occult metastasis in early stage supraglottic laryngeal carcinoma. We selected carefully 32 T1–2 clinically N0 patients without epilarynx involvement and 39 T1–2 clinically N0 patients with epilarynx involvement from among patients with supraglottic laryngeal carcinoma. All patients underwent simultaneous unilateral or bilateral neck dissection with laryngeal surgery. The rate of the occult metastases was 3.1% in patients without epilarynx involvement, whereas it was 20.5% in patients with epilarynx involvement. Within the supraglottic larynx, two subregions can be distinguished: the epilarynx and the lower supraglottis. Our results suggest the possibility of omitting elective neck treatment in T1–2N0 supraglottic laryngeal carcinoma without epilarynx involvement. Observation under strict follow-up may be an option to routine neck treatment in T1–2N0 supraglottic laryngeal carcinoma without epilarynx involvement.     

Partial laryngeal surgery in recurrent carcinoma

With the growing acceptance of nonsurgical therapies for laryngeal squamous cell carcinomas (LSCCs), it has become important to delineate surgical salvage strategies for disease recurrences. Total laryngectomy is often recommended, but appropriately selected laryngeal recurrences may be treated successfully with partial laryngeal surgery: laryngeal function can be preserved with oncological efficacy. The main available studies dealing with partial laryngeal surgery in recurrent carcinoma were critically reviewed. The most appealing feature of salvage transoral laser surgery (TLS) is the opportunity to make tumor-tailored excisions without any reconstructive limitations and retaining the option to switch to open partial laryngectomy. A recent detailed review of 11 series found a pooled local control rate of 57% after a first TLS procedure. Supracricoid laryngectomy (SCL) seems to achieve good local control rates in selected cases of recurrent supraglottic-glottic carcinoma: one review considering seven series calculated that 85% of the patients treated with salvage SCL after radiotherapy experienced no local recurrence; and total laryngectomy after failure of salvage SCL afforded an overall local control rate of 65%. Neck dissection is mandatory in all cases of local LSCC recurrence with evidence of neck metastases, and routine elective neck dissection is recommended for recurrent supraglottic and transglottic cancers.     

CO<Subscript>2</Subscript> laser treatment of laryngeal stenoses after reconstructive laryngectomies with cricohyoidopexy,cricohyoidoepiglottopexy or tracheohyoidoepiglottopexy

Supracricoid laryngectomy with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) is a conservative laryngeal surgery tailored to T1b-T2-T3 glottic-supraglottic carcinomas. Tracheohyoidopexy (THP) and tracheohyoidoepiglottopexy (THEP) allow a chance of conservative surgery also for selected transglottic carcinomas. These techniques are comprehensively named reconstructive laryngectomies (RLs). Post RL laryngeal stenosis not due to carcinoma persistence or recurrence is an unusual occurrence. The aim of the present study has been to analyse retrospectively and describe the treatment of the cases of laryngeal stenosis after RL, which occurred in Vittorio Veneto Otolaryngological Department in a 6 year period. In the period between 1999 and 2004, 225 patients underwent RL in our Department. In 18 of them (8%) a laryngeal stenosis after RL was diagnosed. The same evidence was shown in 2 patients who underwent RL in other Institutions. All patients underwent CO₂ laser surgical treatment of the laryngeal stenosis. The 14 patients who underwent RL-CHEP, the 5 patients who underwent THEP and the patient who underwent CHP were treated on average with CO₂ laser 1.2 (range 1–2), 4.2 (range 2–7), and 2 times, respectively. Decannulation was possible in all patients but one after CO₂ laser treatment of the stenosis in a mean period of 3.4 months. Laryngeal stenoses after RLs can be successfully treated with CO₂ laser excision with a very limited morbility. The only reasonable contra-indication to CO₂ laser excision could be a cranio-caudal length of the laryngeal stenotic tract longer than 1 cm: in this occurrence diagnosed after THP or THEP, an external surgical approach could be preferred.     

Transoral Robotic Surgery Using a Carbon Dioxide Flexible Laser for Tumors of the Upper Aerodigestive Tract

Objective: To determine the safety, feasibility, and efficacy of coupling transoral robotic technology with the flexible carbon dioxide (CO₂) laser for various tumors of the oropharynx and supraglottic larynx. Study Design: Prospective, pilot trial. Methods: Eight patients were enrolled in an IRB‐approved prospective trial for transoral robotic surgery with the aid of the flexible CO₂ laser. Results: Seven male patients with early carcinoma of the oropharynx or larynx successfully underwent tumor extirpation with the transoral robot and the flexible CO₂ laser. We were unable to gain access to the supraglottic larynx in one female patient. The final pathology revealed seven patients with squamous cell carcinoma and one patient with adenoid cystic carcinoma. The flexible CO₂ laser provided fine incisions with excellent hemostasis and minimal peripheral tissue injury. Additionally, the laser provided an excellent tool for raising pharyngeal flaps for reconstruction of the oropharynx. Conclusion: The flexible CO₂ laser offers a unique advantage of precise incisions and may provide a valuable tool for both tumor extirpation and the creation of flaps for transoral robotic reconstruction.     

Is routine bilateral neck dissection absolutely necessary in the management of N0 neck in patients with supraglottic carcinoma?

The supraglottic larynx has a rich lymphatic network that places patients with supraglottic laryngeal carcinomas at high risk for early dissemination of the disease into the cervical lymphatics. Therefore, elective neck treatment of clinically N0 neck in patients with supraglottic carcinomas is widely accepted as a standard approach. However, the issue whether elective neck treatment should routinely be directed on both sides of the neck is still controversial. The present study is aimed at determining whether T2–T4 stage supraglottic carcinomas require bilateral neck dissection in the management of N0 necks. We designed a prospective study on 72 patients with N0 supraglottic laryngeal carcinoma. Patients were divided into three groups according to the site and extension of the primary tumors. Group I consisted of 21 patients with lateralized (clear lateral) lesion reaching but not crossing the midline. Group II comprised 25 patients with cancer largely involving one side and crossing to the midline. Group III included 26 patients with carcinoma equally involving both sides of the larynx or growth into the midline larynx. All patients underwent bilateral lateral neck dissection in conjunction with various types of laryngectomies selected to the status of the primary. Of the 72 patients, 16 were found to have occult regional metastases in pathologic examination (9 pN1, 4 pN2b, 3 pN2c). The prevalence of occult metastases proportionally increased with T stage from 8.3 to 22.7 and 31.2%, respectively, for T2, T3 and T4. Bilateral neck metastases were found in 2 of 26 patients (7.7%) with central lesions. There was only one patient (4%) with both ipsilateral and contralateral lymph node metastasis in group II. None of the 21 patients with lateral lesion (group I) had contralateral neck metastasis. Routine bilateral elective neck dissection may not be a part of the surgical procedure in all supraglottic laryngeal carcinoma patients. Bilateral neck dissection should be preferred for cases with central tumors and lateral tumors with positive nodes in the ipsilateral side of the neck.     

Supraglottic carcinoma: a 10-year review at the University Hospital

The records of all patients with supraglottic laryngeal cancer seen and definitively treated from 1961 to 1970 at the University Hospital were reviewed. The total number of carcinomas felt to arise primarily from the supraglottic area was 118. Of these, 89 had what we considered sufficient follow-up to be used in tabulating the results of treatment. Tumors irradiated primarily received 6,500 R Cobalt therapy. There were 50 of the 89 patients who received primary irradiation therapy. Thirty-one of the patients received primary surgical therapy. Of these, three had laryngectomies only, seven partial laryngectomies and neck dissections, and the remaining patients had total laryngectomies and neck dissection. Only eight of the 89 patients received initial combined therapy, or surgery and irradiation within three months of each other. In our experience, supraglottic cancers without nodal metastasis, regardless of size, will have about 73 percent absolute three-year survival, whether treated with irradiation or surgery primarily. The absolute three-year survival for supraglottic carcinomas with nodal metastasis and primary irradiation therapy was 6 percent. On the average, these were larger lesions with nodal metastasis. The absolute three-year survival for supraglottic carcinomas with nodes receiving primary surgery was 23 percent. These were significantly smaller lesions than those irradiated primarily. Of the patients without lymph node metastasis, 24 percent of the supraglottic lesions irradiated primarily developed laryngeal recurrences requiring secondary therapy. None of the patients with similar lesions receiving primary surgery developed laryngeal recurrences. Of the supraglottic carcinomas with nodal metastasis and receiving primary irradiation, 75 percent developed local recurrences and 83 percent had persistent or recurrent neck metastasis in the same neck. Of the patients with similar lesions receiving primary surgery, 20 percent developed local recurrences and 33 percent developed recurrent neck metastasis in the same neck. The alternatives of treatment for primary therapy of a supraglottic carcinoma without nodal metastasis are either full dose irradiation or a partial laryngectomy, if possible, and a neck dissection. Supraglottic carcinomas with evidence of nodal metastasis are probably best treated surgically, in some cases in combination with irradiation therapy.     

Endoscopic CO2 laser therapy of selected cases of supraglottic marginal tumors

Endoscopic CO₂ laser intervention can be used as conservation surgery for supraglottic laryngeal carcinomas in carefully selected patients. We analyzed retrospectively our experience in managing patients with early supraglottic carcinomas operated on at the Clinic of Otorhinolaryngology, Szeged, Hungary, during the 10-year period between 1987 and 1997. Conservation surgery was the treatment of choice in 187 patients, but only 23 (12%) were selected for endoscopic CO₂ laser surgery. Laser surgery was indicated predominantly for T1 cancer of the epiglottis (n = 15), but was also performed for T2 cancers (n = 8). Of the 23 supraglottic tumors treated, 16 had no signs of recurrence to date (1.5 to 9 years after surgery) a local control rate of 70%. Six patients with recurrences underwent salvage therapies that included repeated laser excisions (n = 3), radiotherapy (to 60 Gy), horizontal supraglottic laryngectomy and total laryngectomy. One patient was not resectable because of multiple metastases. Our experience with endolaryngeal CO₂ laser excision indicates that it is a reasonable method in selected cases of supraglottic tumors, but one-third of the patients required salvage treatment. Recieved: 28 September 1998 / Accepted: 15 March 1999     

Endoscopic supraglottic laryngectomy with postoperative irradiation

Sixty-eight consecutive patients with infiltrating squamous cell carcinoma of the supraglottic larynx were referred to the senior author (R.K.D.) from January 1987 through December 1999. Forty-six patients (clinically staged T2) were selected to undergo endoscopic carbon dioxide laser supraglottic laryngectomy. Thirty-eight of these patients underwent planned postoperative irradiation. The other 8 patients were treated by surgery only, either because they had previously undergone irradiation or because they had refused postoperative irradiation. Eighteen cases (39%) were restaged from T2 to T3 on the basis of preepiglottic space invasion demonstrated on final pathology review. Primary site control was maintained in 97% of the combined-therapy patients and in all of the surgery-only patients without any salvage procedures. Regional control was attained in 96% of NO patients treated with irradiation alone, and 91% of N+ patients treated with modified radical neck dissection and postoperative irradiation. The combined-therapy group had only a 3% gastrostomy dependency rate, no tracheotomy dependency, a 5% aspiration pneumonia rate, and an average onset of independent swallowing at less than 2 weeks.     

Transoral carbon dioxide laser supraglottic laryngectomy and irradiation in stage I, II, and III squamous cell carcinoma of the supraglottic larynx: report of Southwest Oncology Group Phase 2 Trial S9709

OBJECTIVE: To evaluate feasibility, functional outcome, and disease control of endoscopic surgery and irradiation in patients with squamous cell carcinoma of the supraglottic larynx. DESIGN: Prospective, single-arm, phase 2 multi-institutional trial. SETTING: Southwest Oncology Group trial S9709. PATIENTS: Thirty-four patients diagnosed as having stage I, stage II, or selected stage III (T1-2N1M0) supraglottic laryngeal carcinoma enrolled from September 15, 1997, to December 1, 2001. INTERVENTIONS: Transoral supraglottic laryngectomy by carbon dioxide laser followed by planned postoperative radiotherapy. MAIN OUTCOME MEASURES: Three-year progression-free survival, proportion of patients requiring tracheostomy as a result of surgery, and time to adequate oral intake. RESULTS: All 34 patients underwent surgery without major protocol deviation. Thirty-two patients (94%) completed planned postoperative radiotherapy without major deviation. At the time of analysis, only 1 patient (3%) had documented local disease recurrence at the primary disease site and required salvage total laryngectomy, and 2 patients (6%) had documented regional recurrence and required salvage neck dissection. Estimated 3-year progression-free survival and overall survival were 79% and 88%, respectively. No subjects required tracheostomy as a direct consequence of endoscopic resection. Patients who required tracheostomy before endoscopic resection due to either obstructive tumor bulk or unfavorable anatomy that precluded safe intubation (4 patients [12%]) were all decannulated in the early postoperative period (相似文献   

Transoral robotic-assisted free flap reconstruction after radiation therapy in hypopharyngeal carcinoma: report of two cases

The objective was to assess the feasibility and safety of transoral robotic surgery (TORS)-assisted free flap reconstruction for hypopharyngeal carcinoma after radiation therapy. The study evaluated the feasibility, surgical margins, the need for a tracheotomy, a nasogastric tube as well as surgery-related complications. Two patients underwent TORS-assisted free flap reconstruction after radiation therapy. The resection margins were free of tumor in both patients. A tracheotomy was performed in one patient who had been decannulated on the sixth postoperative day. One patient resumed satisfactory oral feeding in the fourth postoperative month and the second patient on postoperative day 7. No intraoperative complication and one postoperative complication (neck hematoma) were reported. After a follow-up period of 24 and 30 months, no local recurrence was observed. TORS is feasible for hypopharyngeal resection and assisted free flap reconstruction after radiation therapy. It represents a further step in the development of minimally invasive surgery for the treatment of head and neck cancers with laryngeal preservation.     

Transoral carbon dioxide laser resection of supraglottic carcinoma.

Between 1981 and 1994, 34 patients with squamous cell carcinoma of the supraglottis were treated by transoral carbon dioxide laser resection, 12 of them palliatively. Additional treatment included neck dissection in 21 patients and radiotherapy in 24 patients. The 3-year overall survival was 62%, and the actuarial survival 80%. The overall survival for T1 and T2 tumors was 71%, and that for T3 and T4 tumors was 47%. The overall 3-year survival for the early stages, I and II, was 88%, and that for the advanced stages, III and IV, was 50%. These results are comparable to the outcome after conventional open partial resection. Given the significantly lower morbidity (only 7 patients required tracheostomy), we do not observe an age limit anymore. The transoral method can be recommended as curative treatment in T1 and T2 tumors and in selected T3 and T4 tumors in concert with neck dissection and/or radiotherapy. In patients with advanced inoperable tumors, laser surgery is an excellent alternative to tracheostomy and palliative radiotherapy. Prerequisites for successful application of the transoral carbon dioxide laser resection are adequate resection techniques.     

声门上癌术后颈淋巴结的转移与再发

探讨选择性颈廓清术在声门上癌手术治疗中的作用。方法总结１９８１－１９９３年治疗的５８２例声门上癌术后颈淋巴结转移及廓清侧转移淋巴结再发情况。结果Ｔ３、Ｔ４病例３９２例,而Ｔ３Ｎ＋、Ｔ４Ｎ＋１４７例。     

Endoscopic resections of glottic and supraglottic carcinomas with the C02 laser

Clinical experiences with transoral CO₂ laser resections of glottic and supraglottic carcinomas are presented. 47 patients with variously sized supraglottic tumors and 114 patients with early glottic cancers were treated at the University of Kiel from 1979 to 1993. Although 10 patients with glottic tumors developed recurrences, curative treatment was possible with either repeat laser surgery (3 cases), irradiation (3 cases) or salvage laryngectomy (3 cases). One patient refused further treatment. Among the 30 patients with supraglottic lesions treated for cure 18 are currently alive and free of disease. 6 patients died with no evidence of disease, 2 patients died from secondary malignancies and 3 patients succumbed to their tumors. Present findings justify routine use of laser resections of laryngeal neoplasms, although patients must still be carefully selected for treatment.Presented at the combined meeting of the Society of Head and Neck Surgeons and the European Organization for Research and Treatment of Cancer, Paris, France, 25–28 May 1994     

Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy

With the increasing use of concomitant chemoradiotherapy (CCRT) in the treatment of advanced head and neck carcinoma, surgery has lost ground as the first therapy and is reserved as a salvage treatment in cases of locoregional failure. The objective of our study was to review our experience in patients who had a local or regional recurrence after treatment with CCRT. Thirty-two patients underwent salvage surgery after CCRT: 24 were treated with a local or locoregional resection and 8 patients with a neck dissection only. In patients who had surgery involving the primary location of the tumor, some kind of reconstruction was required in 83% of cases. One or more postoperative complications occurred in nine patients. The median hospital stay was 18.5 days. There was a significant difference in hospital stay in relation to the appearance of surgical complications. Five-year adjusted survival after salvage surgery was 34.2% (CI 95% 13.2–55.2%). Adjusted survival was related to the status of the resection margins and appearance of neck nodes with extracapsular spread in the neck dissection. In conclusion, salvage surgery after CCRT involves extensive resections, requiring reconstruction techniques with regional or microanastomosed free flaps in most cases, achieving acceptable outcomes.     

Management of the N0 Neck During Salvage Laryngectomy

Background: Radiotherapy is effective treatment for laryngeal carcinoma. Early-stage laryngeal carcinoma has a low incidence of cervical metastasis. Patients initially clinically N0 usually remain N0 when they fail at the primary site. The incidence of subclinical metastasis in these patients is not well described. Watchful waiting or elective neck dissections are advocated. Objective: Examine the incidence of subclinical metastatic disease in patients undergoing elective neck dissections with salvage laryngectomy. Study Design: Prospective study (1991–1996) of patients who failed radiotherapy and underwent salvage laryngectomy with elective neck dissection. Methods: Thirty-four patients underwent salvage laryngectomy with neck dissection (30 bilateral, 4 unilateral). All were clinically N0 at initial presentation and remained N0 at recurrence. Pathologic study of the neck dissection specimens was undertaken. Patients were followed for a minimum of 2 years (mean, 4 y). Results: The male-to-female ratio was 4.5:1, with a mean age of 62 years (range, 38 to 75 y). Metastatic disease was present in 6 patients (17%); 4 of 14 (28%) supraglottis and 2 of 20 (10%) glottic. Presence of disease in the neck according to stage at recurrence was as follows: T2, 2 of 12; T3, 3 of 14; and T4, 2 of 8. Neck disease was ipsilateral in 4 and contralateral in 2 patients (both supraglottic primaries). Conclusions: Subclinical cervical metastasis may be present in N0 laryngeal carcinoma patients who have recurrence following radiotherapy. Morbidity of a lateral neck dissection is minimal, with excellent control of the neck being possible. Supraglottic and advanced glottic (T3-T4) patients may benefit the most.     

喉声门上型癌颈淋巴结转移包膜外侵犯的频度和预后

目的 为研究喉声门上型癌同侧颈淋巴结转移包膜外侵犯的频度和预后.方法 总结1994年1月～1997年12月期间177例同期行经典性或改良性颈清扫术喉声门上型癌病例.采用透明淋巴结摘出连续切片法处理颈清扫标本.采用SPSS 11.5软件进行统计学分析,生存分析采用Kaplan-Meier法,结果用Log-Rank方法进行检验.结果 81例标本有颈淋巴结转移,转移率为45.8%,其中32例淋巴结包膜外侵犯,其频度为39.5%(32/81).颈淋巴结转移包膜外侵犯与病理N分级、同侧转移淋巴结个数相关.包膜外侵犯的病例同侧颈部复发率和对侧颈部转移率比无包膜侵犯的病例高.颈部淋巴结转移无包膜侵犯和包膜外侵犯病例的5年生存率分别为61.9%和22.2%,差异有统计学意义.结论 淋巴结转移包膜外侵犯影响患者预后,淋巴结转移包膜外侵犯病例的对侧转移率高,未行同期双侧颈清扫者,应密切随访观察对侧颈部状况.     

Transoral laser surgery for pharyngeal and pharyngolaryngeal carcinomas

OBJECTIVE: To assess early oncological and functional outcomes after transoral laser surgery in patients with pharyngeal or pharyngolaryngeal squamous cell carcinoma. DESIGN: Inception cohort, with a median follow-up of 24 months. SETTING: Tertiary university center. PATIENTS: Fifty-five consecutive patients with pharyngeal or pharyngolaryngeal squamous cell carcinoma (T1, 24 patients; T2, 28 patients; and T3, 3 patients) were included. Patients had to be eligible for open functional surgery, and exposure in suspension micropharyngoscopy had to be possible. INTERVENTIONS: The pharynx and larynx were exposed with a bivalved laryngopharyngoscope, and the resection of the tumor was performed with a carbon dioxide laser coupled to a microscope. Neck dissection was performed in 43 patients. It was not attempted in the other 12 patients for the following reasons: N0 neck and severe comorbidities (n = 6), microinvasive cancer (n = 3), patient's refusal (n = 1), inoperable N3 disease (n = 1), and rapid local recurrence (n = 1). Eighteen patients (33%) received adjuvant radiotherapy: 12 for neck disease and 6 for positive resection margins. MAIN OUTCOME MEASURES: Local control and overall survival at the median follow-up visit. Evaluation of complications, pain, and rehabilitation of swallowing capacity. RESULTS: At a median follow-up of 24 months, the local control rate was 90%, and the overall survival rate was 78%. There were 16 early postoperative complications: recurrent aspiration pneumonia (n = 7); laryngeal obstruction, which required tracheotomy (n = 3); severe postoperative hemorrhage (n = 2); and cervical emphysema, which resolved spontaneously (n = 4). Feeding tubes were necessary in 37 patients. They were removed after a median period of 7 days. The median pain score was 4 of 10 during the first postoperative week and 0 of 10 after 4 weeks. The median hospital stay was 13 days (15 days for patients with neck dissection). CONCLUSIONS: Transoral laser surgery for pharyngeal and pharyngolaryngeal squamous cell carcinoma is a safe and acceptable therapeutic modality in selected cases. Good local control and avoidance of tracheotomy can be expected in most cases. Oral food intake is immediate, but feeding tubes are required to avoid weight loss during the postoperative period. Frequent early problems include transient postoperative bronchoinhalations and pain.     

Transoral CO2 laser surgery for supraglottic cancer

There are several therapeutic options for laryngeal cancer, including those that provide a functional preservation without worsening the oncological results, such as transoral laser microsurgery (TLM). The aim of this study was to analyze both oncological and functional results of TLM in supraglottic cancer. We studied 49 consecutive patients with a primary supraglottic carcinoma who underwent a TLM between the years 1999 and 2009. Nineteen patients were classified as stage I–II and 30 as stage III–IV disease. Forty-five patients underwent also neck dissection. Thirteen patients received postoperative radiotherapy. The minimum follow-up was 24?months. Three- and five-year disease-specific survival rate was 93.2 and 82.2?%, respectively. Of the patients, 36.7?% had some complication after surgery, aspiration being the most frequent (16.32?%). Of the 43 patients who were alive, 39 (91?%) without evidence of disease 3?years after diagnosis had a functional larynx. Our results suggest that TLM is a safe and effective treatment for supraglottic cancer, with a low morbidity rate and excellent functional results.