Functional and Oncological Outcomes of Primary versus Salvage Transoral Laser Microsurgery for Supraglottic Carcinoma

Abstract

Objective To evaluate the functional and oncologic outcomes of transoral laser microsurgery (TLM) in patients with previously untreated supraglottic carcinoma compared with salvage cases after radiation-based treatment. Methods We conducted a retrospective case-control study at a single academic tertiary care institution. Functional outcomes were stratified by prior radiation, and assessed at baseline, <1 week postoperatively, and last follow-up. Results Five patients underwent TLM for previously untreated disease and five previously radiated patients underwent salvage TLM for local failure. No patient required tracheostomy. There was no local recurrence after TLM as primary therapy and none required radiotherapy. One salvage patient developed local recurrence. Length of feeding tube dependence (p=0.049) and rates of chronic aspiration (>1 month postoperatively, p=0.048) were significantly higher in salvage TLM cases compared with previously untreated cases. Median PSS-HN Understandability of Speech scores were 75 (“usually understandable”) in the salvage group compared with 100 (“always understandable”) in the previously untreated group. Conclusions Both local control and function were superior in previously untreated patients compared with salvage patients. Our findings provide support for the use of TLM as a primary treatment modality for selected supraglottic carcinomas, but also suggest a potential for functional recovery in both previously untreated and salvage cases.

Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers

“…Moreover, salvage surgery after failed TLM in supraglottic tumors may be performed by all types of open partial laryngectomies, including horizontal supraglottic and supracricoid procedures, whereas in case of recurrent T3 glottic lesions the most frequent salvage surgical procedure is still total laryngectomy. 23,24 Even though this study was not specifically designed for evaluation of functional outcomes, addressed in other reports from our institutions, 9,25,26 it clearly confirms how reduced morbidity of TLM in early T categories does not seem to be greatly influenced by its application in more advanced lesions, such as those described in the present report. Undoubtedly, the incidence of major surgical and medical complications is lower than those commonly reported after open partial laryngectomies and nonsurgical organ preservation protocols.…”

“…The narrow space of work in the posterior paraglottic space in comparison with the relatively wider view allowed at the supraglottic level may also be crucial in determining a higher failure rate. Moreover, salvage surgery after failed TLM in supraglottic tumors may be performed by all types of open partial laryngectomies, including horizontal supraglottic and supracricoid procedures, whereas in case of recurrent T3 glottic lesions the most frequent salvage surgical procedure is still total laryngectomy …”

Evaluating organ preservation outcome as treatment endpoint for T1aN0 glottic cancer

“…LFS is defined as time to laryngectomy, time to recurrence, or time to death from any cause. This definition fails to appreciate that many of the recurrences from previous TLM could be salvaged with repeated organ‐preserving partial laryngeal surgery (TLM or open partial surgery), thereby maintaining the functionality of the larynx. Hence, we propose utilizing laryngectomy‐free disease‐specific survival (LFS‐DSS) to more accurately depict the success of “organ preservation” treatment in this group of patients with early laryngeal cancer.…”

Salvage Transoral Laser Microsurgery for Radiorecurrent Laryngeal Cancer: Indications, Limits, and Outcomes

“…This finding is supported by Hutcheson et al, who compared in a retrospective case-control study functional outcomes of TLM in patients with previously untreated supraglottic carcinoma with post-irradiation salvage cases. Length of feeding tube dependency and rates of chronic aspiration were significantly higher in the salvage TLM group [ 29 ].…”