Laser Surgery for the Treatment of Larynx Carcinomas: Indications, Techniques, and Preliminary Results

Abstract

The authors have developed four different types of endolaryngeal laser resections for the treatment of larynx carcinomas. These new techniques are based on traditional concepts employed in partial larynx resections. From 1986 onward, 110 patients with laryngeal cancers were treated by endoscopic laser surgery. One hundred six patients were operated on for cure and 4 for palliation. In 9 cases of T3 tumor, complete removal of the tumor was not possible, requiring total laryngectomy. In all T2 cancers of the glottis and subglottis (n = 36), a total resection was possible. Additional staged neck dissection was performed in 16 cases, and postoperative radiotherapy in 10 cases. Follow-up investigations of the patients treated for cure (n = 106) cover a period of 3 to 42 months (mean, 22 months). These revealed 6 recurrences in the larynx, which were treated by laryngectomy. Recurrences in the cervical nodes were seen in 2 patients following resection of a supraglottic tumor and a subglottic tumor, respectively. Seven patients could not be followed up, 4 patients died of intercurrent disease, and 87 patients are alive and free of tumor. At present the number of recurrences and the rate of survival show no significant difference from those previously reported after conventional surgery. The phonatory function is not always predictable and still remains to be investigated. The authors believe that laser surgery may obviate the need for total laryngectomies in selected cases of laryngeal cancer, especially in T2 tumors. However, T3 tumors should not be treated by endolaryngeal laser surgery.

Endoscopic CO2‐Laser Surgery for Vocal Cord Cancer

“…Laser surgery can be extended (SteineretaL, 1991;Eckel and Thumfart, 1992) to extensive superficially growing car cinomas, and so it seems to be an effective approach to the curative treatment of Tlb and "1"2 tumors of the glottis with a fairly high recurrence rate (Hirano and Hirade, 1988; Inouye and Tanabe, 1988). This was illustrated in our patients, in whom stages Tlb and T2 success rates were 78% and 75%, respectively.…”

“…It seems reasonable to define different types of endolaryngeal resections (Kaufman, 1986;Eckel and Thumfart, 1992). Our 6 years ofexperience with this technique also led us to form different subgroups of endoscopic cordectomy.…”

“…1) Patients must be medically eligible for endoscopic surgery using suspension laryngoscopy; 2) Adequate exposure must be obtained so that the entire lesion can be visualized; and 3) The lesion must be confined to the true ENDOSCOPIC CO2-LASER SURGERY FOR VOCAL CORD CANCER 73 vocal fold. Studies of the anatomic limitations of laser cordectomy (Davis, 1990) (Kaufman, 1986;Eckel and Thumfart, 1992). Our 6 years ofexperience with this technique also led us to form different subgroups of endoscopic cordectomy.…”

Erken evre larenks karsinomunda konvansiyonel cerrahi ve transoral radyofrekans ablasyonunun histopatolojik sonuçlarının karşılaştırılması

“…[8] In selected early stage cancers, the cure rates in open surgical excision and radiotherapy are the same. [8,9] Thumfart [10] reported that resection of early stage laryngeal carcinoma with cauterization gave only minor postoperative hemorrhage and granulation tissue. In our study, resection with cauterization resulted in only minor hemorrhage compared with open surgical excision.…”

Co2 Laser – A New Tool in the Surgeons Armamentarium

“…Steiner [5] also opined that C02 laser surgery gives excellent results in stage I g lottic cancer with better quality of voice. He also opined that C02 laser can easil y be extended safely to all T2 and selected T3 or T4 laryngeal resection and thus obviating the need for total laryngectomies [6].…”