Preliminary Oncological Results of a Multimodality Treatment Regimen with Transoral Laser Surgery, Neck Dissection and Postoperative Irradiation in Advanced Laryngeal Carcinomas

Abstract

Background: CO₂ laser surgery is a generally accepted treatment modality in early stage I cancers. The aim of our study was to determine the role of transoral laser surgery in a multimodality treatment regimen with neck dissection and postoperative irradiation in advanced laryngeal carcinomas. Patients and Methods: From June 1993 to December 1996 we examined 40 patients (32 men, 8 women; mean age 59 years) with advanced laryngeal squamous cell carcinomas (stages III and IV: 95%, stage II: 5%) who underwent a multimodality treatment regimen with transoral laser surgery, bilateral neck dissection, and postoperative irradiation. Median follow-up time was 39 months. Results: The 3-year overall survival rate was 85%. The local and regional recurrence rates were 37.5 and 27.5%, respectively. Postoperative complications which were related to the laser surgical intervention occurred in 5 patients (12.5%). Conclusions: The oncological results of transoral CO₂ laser surgery combined with bilateral neck dissection and postoperative irradiation are satisfying if clean surgical tumor margins (R0) can be reached. In patients in whom tumor-free margins are not achieved (R1 and R2 resections) and transoral revision is not possible, transcervical procedures (total or partial laryngectomy) should be performed. The 3-year overall survival rate of 85% following laser surgery with bilateral neck dissection and postoperative irradiation indicates a promising alternative to other combined treatment modalities which include radical laryngectomy.