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

Abstract

OBJECTIVE: To investigate the oncologic and survival outcomes of primary transoral laser microsurgery in laryngeal cancer. DESIGN: Retrospective analysis of a database of all patients undergoing primary transoral laser microsurgery with or without adjunctive therapy from June 2000 to October 2013. The median follow-up time was 33 months. SETTING: A teaching hospital. PARTICIPANTS: Two hundred and three patients underwent primary transoral laser microsurgery. Of these, 166 had glottic and 37 had supraglottic squamous cell carcinoma. MAIN OUTCOME MEASURES: Overall survival, disease-specific survival, local control and rate of salvage laryngectomy. RESULTS: Primary transoral laser microsurgery was performed exclusively in 149 (73%) patients, 16 (8%) had transoral laser microsurgery followed by postoperative (chemo)radiotherapy, 6 (3%) had transoral laser microsurgery with neck dissection, and 32 (16%) had transoral laser microsurgery in combination with neck dissection and postoperative (chemo)radiotherapy. In glottic cancer, the 5-year local control was 86%, 86% and 76% in carcinoma in situ (Tis), early-stage (T1, T2) and late-stage (T3, T4) disease, respectively. The 5-year disease-specific survival was 93% in Tis, 96% in early-stage and 65% at late-stage disease. In supraglottic cancer, the 5-year local control was 66% in early-stage and 88% in late-stage disease. The 5-year disease-specific survival was 80% and 75%, respectively. The rate of salvage laryngectomy was 9.9%. CONCLUSION: In carefully selected patients with laryngeal cancer, primary transoral laser microsurgery with or without adjunctive therapy can be organ preserving. It can provide a valid treatment option for patients.