The ideal treatment for malignant laryngeal tumors – in a previous article I described what laryngeal cancer is, as well as its symptoms and diagnosis – is surgery and among the options that allow preservation of the surgical organ, transoral microsurgery with CO2 (carbonic) laser stands out. Basically, the therapeutic concept is that any tumor for which partial resection with organ preservation seems possible should be treated primarily with transoral laser microsurgery, with the visual aid of the operating microscope.
The goal of transoral laser resection is radical removal of the tumor, supported by the result of intraoperative biopsies, and control of tumor extension by surgical microscopy or laryngeal optics. Currently, too many total laryngectomies are still performed in patients who would have been good candidates for larynx-sparing treatment.
Advantages of transoral laser microsurgery
Here are some of the advantages of transoral laser microsurgery over other treatments:
– Avoids resection of healthy tissue
– Preserves structures that facilitate swallowing (sensitive nerves, musculature).
– Very low perioperative morbidity and mortality and low postoperative morbidity.
– No reconstructive surgery required
– Can be repeated
– Avoids external incisions (less pain)
– Avoids tracheotomies and total laryngectomies
– Less intraoperative blood loss
– Shorter hospital stay and reduced treatment costs
– Possibility of integration into other therapeutic concept models (radiotherapy or chemotherapy)
– Possibility of early initiation (2-3 weeks) of adjuvant radiotherapy.
– Possibility of switching to open surgery, both in the first and second instance.
– Less stress (patient, family and surgeon)
– Good rehabilitation of swallowing and voice.
– Rapid reintegration into family, social and work life
– Easy endoscopic follow-up (except pyriform sinus).
– Favorable psychological situation due to the preservation of the organ.
To guarantee the success of transoral surgery, especially when the intention is curative in advanced tumors, it is important to meet certain prerequisites. Among other conditions for a safe oncological resection with organ preservation, the surgeon’s experience in the use of this technique and the good exposure of the tumor, essential to facilitate the identification of a healthy tissue margin, are important. The thorough analysis of the margins by the pathologist is the basis for the verification of a perfect resection. Compared to conventional surgery, transoral laser microsurgery, especially in large tumors, performs more surgical margin investigations.