Transoral laser microsurgery for laryngeal and hypopharyngeal cancers
Treatment options for laryngeal and hypopharyngeal cancer include:
- Radiotherapy
- Surgery
- Chemotherapy
- Targeted therapy
- Immunotherapy
One or a combination of radiotherapy, surgery, and chemotherapy may be used to treat the cancer. Surgery and radiotherapy are the most common options. Chemotherapy may be used before or during radiotherapy and/or surgery to increase chance of destroying cancer cells. Immunotherapy and targeted therapy are mostly reserved for recurrent or metastatic disease.
What is transoral laser microsurgery?
Transoral laser microsurgery (TLM) is a minimally invasive, endoscopic surgical technique for the management of oropharyngeal, hypopharyngeal and laryngeal carcinomas. In comparison with traditional open surgery, TLM allows obviating scar of the neck, reducing morbidity, shorter hospital stay, fewer complications, and better functional outcomes.
How is it done?
Under general anesthesia, the oropharynx/hypopharynx/larynx was suspended and exposed with a rigid laryngoscope, and 0°, 30°, and 70° endoscopes were used to examine the extent of tumor invasion. A narrow-band imaging system was subsequently used to perform a detailed inspection of the vascular patterns of the tumor and surrounding tissues. Video recording was performed before, during, and after surgery. The procedure was performed using CO2 laser equipment with a micromanipulator.
During the operation, the tumor was transected into manageable units by the laser to identify the depth of tumor invasion and to determine the optimal deep tumor margin. As a result, the tumor was removed in pieces (piecemeal resection).
Why is it done?
This procedure confers several advantages:
- The ability to thoroughly map the extent of tumor invasion, ensuring a safe margin and minimizing healthy tissue loss during surgery.
- Preserve the larynx and hypopharynx as much as possible for better functioning (swallow/speech) after surgery.
- Avoidance of tracheostomy.
- More options for salvage treatment if tumor recurrence.
Risk and complications
Complications after transoral laser surgery include:
- Postoperative bleeding
- Infection
- Emphysema
- Airway ignition
- Dyspnea
- Dysphagia or aspiration pneumonia
- Damage to your teeth
- Temporomandibular joint dislocation
Serious sequelae and mortality rate are low.
Operative figures
Figure 1. Left glottic cancer, T2N0M0
Figure 2. Surgery image
Figure 3. TLM: type 6 laser cordectomy
Figure 4. Post-treatment 3 month
Estimated Cost
For estimated medical costs, please contact International Medical Services Center.