Transoral Laser Microsurgery for Supraglottic Cancer

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Surgical Oncology

Background:

• Transoral laser microsurgery (TLM) is a recognized treatment for supraglottic carcinomas.
• While effective for early stages, its role in locally advanced disease and associated functional outcomes require further investigation.
• This study evaluates the oncologic and functional results of TLM in a large patient cohort.

Purpose of the Study:

• To analyze the oncologic outcomes (local control, survival) of transoral laser microsurgery (TLM) for supraglottic carcinomas.
• To assess the functional outcomes, including swallowing and voice, after TLM treatment.
• To compare TLM outcomes with established surgical and chemoradiation approaches.

Main Methods:

• A retrospective analysis of 91 patients with pT1-pT4a supraglottic carcinomas treated with TLM between 2002 and 2012.
• Tumor staging (UICC 2010) and nodal status were recorded.
• Oncologic outcomes were assessed using Kaplan-Meier survival analysis. Functional outcomes were evaluated using the MD Anderson Dysphagia Inventory (MDADI), Voice Handicap Index-10 (VHI-10), and Performance Status Scale for Head and Neck (PSS-HN).

Main Results:

• The 5-year local control rate was 72%, with an ultimate local control rate of 92%. The 5-year overall survival rate was 63%.
• Postoperative swallowing support (nasogastric tube) was required in 74% of patients, with only 3% PEG-dependent at 1 year.
• Median functional scores indicated favorable swallowing (MDADI: 80) and voice (VHI-10: 35) outcomes, with good dietary function (PSS-HN: 91).

Conclusions:

• TLM achieves oncologic results comparable to open surgery for both early and advanced supraglottic carcinomas.
• Functional swallowing outcomes following TLM are superior to those of open surgery and chemoradiation.
• Patients undergoing TLM report minimal impairment in voice and swallowing-related quality of life.