Current Status of Endoscopic Laser Surgery in Head and Neck Surgical Oncology

Abstract

This review of the Cologne University Medical School experience with oncological laser surgery evaluates the potential role of transoral laser surgery for oral, oropharyngeal, laryngeal and hypopharyngeal carcinoma by reporting the treatment modalities and results in large, unselected cohorts of consecutive patients from a university-based referral center that prefers transoral laser surgery over open surgical approaches for all head and neck cancer cases if such an approach is considered feasible and oncologically sound by the contributing surgeons at our department. It seeks to determine the proportion of all oncological cases that can be managed using a transoral approach and to describe survival, local control and organ preservation rates with endoscopic CO₂ laser surgery. The data presented in this study suggest that transoral laser surgery is no longer a treatment modality that should be restricted to highly selected patients, but may well become a major treatment option for most infiltrating laryngeal and oral carcinomas, for important subgroups of pharyngeal cancer, and for practically all carcinomas in situ and verrucous carcinoma. Additional treatment options are required for the neck if suspect lymph nodes are detectable at the time of primary treatment or if the neck is considered to be at risk for regional metastases. In light of the recent literature on treatment modalities for head and neck carcinoma, the future may bring new roles for surgery and radiotherapy: organ-sparing surgery, including transoral laser surgery, may become a more widespread approach to early-stage disease, while organ preservation programs based on sequential or concomitant chemotherapy and radiotherapy may replace surgery as the most important treatment modality in advanced but resectables stages.