Abstract
Introduction The introduction of laryngeal transoral procedures has created a shift in the treatment of laryngeal cancers towards the primary surgical management of patients. In this study, we aimed to evaluate the safety, efficacy, and feasibility of the transoral laser-assisted total laryngectomy (TLM-TL) in advanced laryngeal cancer. Case presentation. In this case report, we describe a case of a 50-year-old male patient presented to the otorhinolaryngology clinic with a history of hoarseness and odynophagia since 6 months. Based on the pathological and imaging findings, the diagnosis of stage IVa laryngeal squamous cell carcinoma with the involvement of the base, tongue, and left palatine tonsil was made for the patient, and transoral total laryngectomy with partial glossectomy via the TLM technique was planned. Result The tumor was successfully resected by TLM-TL with clear surgical margins. No complication was observed after the surgery. Good functional recovery was obtained regarding swallowing and speech. The patient's oncologic and functional outcomes were evaluated for 2 years. Everything was satisfactory with good long-term cosmetic and laryngopharyngeal functional outcome and no sign of tumor recurrence. Conclusions TLM-TL is a minimally invasive and cost-benefit endoscopic surgical procedure feasible in advanced laryngeal cancer with good long-term oncological and functional outcome. It could limit postoperative complications, mainly the incidence of pharyngocutaneous fistulae. It is also associated with better satisfaction after TL due to cosmetic benefits.
Highlights
An essential part of the management of laryngeal cancer is the preservation of function along with survival rate. ese goals could be achieved via either surgical resection or chemoradiotherapy (CRT), and there is an ongoing debate on which approach is better in terms of oncological results and functional recovery [1, 2]
Several complications have been described for traditional total laryngectomy (TL) such as postoperative mortality and poor functional outcome [7]
Several transoral techniques have been described for head and neck cancer, including transoral laser microsurgery (TLM), transoral robotic surgery (TORS), and transoral ultrasonic surgery (TOUSS) [1]
Summary
An essential part of the management of laryngeal cancer is the preservation of function along with survival rate. ese goals could be achieved via either surgical resection or chemoradiotherapy (CRT), and there is an ongoing debate on which approach is better in terms of oncological results and functional recovery [1, 2]. Due to the significant toxicity of CRT regimens, there has been a resurgence of interest in the primary surgical management of patients with head and neck cancer [6]. Laryngeal transoral procedures have been developed to avoid the morbidity associated with either traditional open surgery approaches or CRT [8]. Several transoral techniques have been described for head and neck cancer, including transoral laser microsurgery (TLM), transoral robotic surgery (TORS), and transoral ultrasonic surgery (TOUSS) [1]. E major advantages of transoral procedure over the conventional open surgery include the comparable oncologic results to TL with good functional outcomes [9]. TLM is a preferred option for laryngeal cancers, and several studies have described this technique in intermediate. Patients with extensive tumors (T3 and T4) usually require a TL procedure which could be performed via the transoral approach [14]. is study aimed to evaluate the safety, efficacy, and feasibility of TLM-TL
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