In patients with advanced laryngeal cancer, TLM with or without radiotherapy is also a viable option for that can help preserve the larynx (Arch Otolaryngol Head Neck Surg 2007;133:1198-1204).
Explore This IssueJuly 2008
Additionally, the procedure may have a role as a salvage therapy for select patients with previously treated laryngeal or pharyngeal squamous cell cancer, according to Mayo Clinic data presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 2007 meeting last fall.
In a prospective case series, 109 patients received salvage TLM for recurrent primary tumors, while 55 underwent the treatment for new primary cancers in a previously treated site. The two-year local control rate was 75%, whereas locoregional control was 72%. Overall survival and two-year disease-free survival rates were 70%.
This was a select group of patients, and their tumors and surrounding tissue received a close frozen section analysis, allowing for comprehensive treatment, said Dr. Salassa.
Transoral laser microsurgery is not an option when the primary tumor invades the neck and involves carotid arteries, said Dr. Hinni, adding that an open operation is generally required.
However, in some cases where tongue base and tonsil cancers have spread into the neck and encased nearby blood vessels, the surgeon may be able to remove intraoral tumors with a laser and then resect the rest through the neck, said Dr. Salassa.
Another contraindication for TLM is when the primary tumor and the cancerous lymph nodes are quite large and emerge together, said Dr. Hinni.
Additionally, if the patient has laryngeal cancer and so much of the organ has to be removed that it prevents the larynx from functioning, TLM should not be used, said Dr. Salassa.
If open reconstruction is necessary for functional or cosmetic reasons, there is no added benefit of using TLM, said Dr. Hinni. For example, mouth cancer that has grown into the jawbone will require replacing the mandible with a fibula. Under these circumstances, the surgeon has to open up the patient, he explained.
Physicians also avoid TLM if the patient’s neck is too stiff and cannot be pushed back or the mouth or jaw is too small, preventing instrument access to the tumor, said Dr. Caruana.
Moreover, if patients cannot tolerate anesthesia for medical reasons, such as significant lung or heart disease, they may not be good candidates for TLM, added Dr. Caruana.
Transoral laser microsurgery offers many advantages over more traditional therapies, such as open surgery and chemoradiation.