Transoral Laser Microsurgery a Viable Option for Head and Neck Patients

In an abstract presented at the AAO-HNS 2007 meeting, Mayo Clinic researchers found that 10 of 701 patients in their database treated with TLM for cancer of the oral cavity, pharynx, and larynx experienced bleeding. Two patients suffered minor bleeds that required observation only. Five patients had major bleeds requiring exploration and treatment under general anesthesia. Three patients had catastrophic bleeds that were life-threatening, two of which resulted in death.

To prevent bleeding, an understanding of anatomy is necessary, said Dr. Salassa. Placing large clips on blood vessels 2 mm or larger, cauterizing smaller vessels, and being careful when dividing and removing tumors that are vascularly tethered to surrounding tissues is also important, he said.

With large tumors, tying off branches of the external carotid system can also help to prevent bleeding, said Dr. Salassa.

As with any surgery, infections are another complication, noted Dr. Caruana. Additionally, fistula formation may occur but is extremely rare and less common than with conventional surgery. The scope in the mouth can also injure teeth and lips, he added.

What Patients Should Know

Before undergoing treatment, every patient should be evaluated by a multidisciplinary head and neck cancer committee and apprised of their options, including radiation and chemotherapy strategies and up-front open surgery or TLM with the possibility of adjuvant therapy, said Dr. Hinni.

Regarding TLM, patients should understand that the procedure treats the primary site of the tumor and that the local control rates are excellent, said Dr. Salassa.

Treatment of head and neck tumors is a very complex topic to discuss with patients, said Dr. Caruana. However, they should know that each case is unique and that if TLM is chosen it is customizable to the individual patient, he concluded.

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