Effect of transoral laser microsurgery vs open partial laryngectomy on the prognosis of patients with early laryngeal carcinoma: propensity score-based analysis

Good and bad indications for adjuvant radiotherapy after transoral laser microsurgery for laryngeal cancer

PURPOSE OF REVIEW

To summarize current evidence regarding the indication of adjuvant treatment after transoral laser microsurgery (TOLMS).

RECENT FINDINGS

Apart from well known risk factors, margins represent the key point in the decision-making. If margins are affected, additional treatment is mandatory. One exception could be the presence of one superficial margin in early tumors that can be strictly followed up by fiberendoscopy. As a general rule, the best option is margin-revision surgery by repeating TOLMS or switching to open partial surgery. (Chemo)radiotherapy can be also considered, being total laryngectomy the last alternative. In locally advanced tumors with uncertain margins (e.g. posterior paraglottic space invasion, vertical anterior commissure reaching the cartilage during primary resection), adjuvant treatment may improve local control with laser but with little impact on disease-specific or overall survival. In this scenario, QoL may be in part reduced after radiotherapy, although recent studies suggest that functional outcomes are favorable. Therefore, decision should be discussed individually with the patient, especially if a total laryngectomy is the only alternative after a possible relapse.

SUMMARY

Considerable work needs to be done to identify those cases that may benefit from adjuvant treatment after TOLMS, including a detailed description of functional outcomes.

Latin American Consensus on the Treatment of Head and Neck Cancer

Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.

Transoral Laser-Assisted Infrahyoid Supraglottic Laryngectomy for Selected Patients With Supraglottic Cancer

Supraglottic laryngectomy has evolved from open to transoral endoscopic approaches with advancements in surgical techniques and instruments such as lasers, endoscopes, ultrasonic devices, and robotics. Transoral laser-assisted microsurgery has emerged as an effective treatment option, offering faster functional recovery and serving as an alternative to partial laryngectomy or non-surgical therapies. Traditional endoscopic supraglottic laryngectomy involves resection of both suprahyoid and infrahyoid supraglottic structures. However, in cases where the tumor is limited to the infrahyoid epiglottis, a new technique known as transoral laser-assisted infrahyoid supraglottic laryngectomy allows for tumor removal while preserving the suprahyoid epiglottis, aryepiglottic folds, and vallecula, ensuring optimal preservation of laryngopharyngeal function. This procedure enables patients to swiftly return to their daily routines with minimal complications. This article discusses the surgical technique, potential indications, and advantages and disadvantages of the new approach for infrahyoid epiglottic cancer.