Matthew H Rigby1, S Mark Taylor. 1. Division of Otolaryngology and Head and Neck Surgery, Dalhousie University, Halifax, NS.
Abstract
OBJECTIVE: There is increasing evidence to support the role of transoral laser microsurgery (TLM) in treating cancers of the upper aerodigestive tract. The article summarizes our experience with TLM and reviews the evidence for TLM as a treatment modality for glottic, supraglottic, and oropharyngeal cancers. Functional results, the role of margins, and postoperative complications are also discussed in relation to TLM. METHODS: MEDLINE reviews were performed to identify experimental or observational studies of outcomes for upper aerodigestive tract cancers treated by TLM. The references of relevant articles were used to identify any studies not detected by initial searches. RESULTS: Over 300 articles were identified relating to outcomes in upper aerodigestive tract cancers treated with TLM. The overwhelming majority of these articles are observational rather than experimental studies. CONCLUSIONS: The efficacy of TLM has been demonstrated for a broad spectrum of upper aerodigestive tract cancers. The best evidence to date supporting TLM comes from prospective cohort series and retrospective cohort comparisons. In early glottic cancer, there is increasing evidence suggesting that a shift toward the use of TLM as the primary treatment modality is oncologically and functionally sound and will provide cost savings. There is significantly less evidence to promote the widespread use of TLM in advanced glottic, supraglottic, and oropharyngeal cancers. However, for indications where outcomes appear similar, the cost benefits of TLM combined with the ability to use radiation as a salvage modality make strong arguments in favour of using TLM as the primary modality.
OBJECTIVE: There is increasing evidence to support the role of transoral laser microsurgery (TLM) in treating cancers of the upper aerodigestive tract. The article summarizes our experience with TLM and reviews the evidence for TLM as a treatment modality for glottic, supraglottic, and oropharyngeal cancers. Functional results, the role of margins, and postoperative complications are also discussed in relation to TLM. METHODS: MEDLINE reviews were performed to identify experimental or observational studies of outcomes for upper aerodigestive tract cancers treated by TLM. The references of relevant articles were used to identify any studies not detected by initial searches. RESULTS: Over 300 articles were identified relating to outcomes in upper aerodigestive tract cancers treated with TLM. The overwhelming majority of these articles are observational rather than experimental studies. CONCLUSIONS: The efficacy of TLM has been demonstrated for a broad spectrum of upper aerodigestive tract cancers. The best evidence to date supporting TLM comes from prospective cohort series and retrospective cohort comparisons. In early glottic cancer, there is increasing evidence suggesting that a shift toward the use of TLM as the primary treatment modality is oncologically and functionally sound and will provide cost savings. There is significantly less evidence to promote the widespread use of TLM in advanced glottic, supraglottic, and oropharyngeal cancers. However, for indications where outcomes appear similar, the cost benefits of TLM combined with the ability to use radiation as a salvage modality make strong arguments in favour of using TLM as the primary modality.
Authors: A T Harris; A Tanyi; R D Hart; J Trites; M H Rigby; J Lancaster; A Nicolaides; S M Taylor Journal: Ann R Coll Surg Engl Date: 2017-10-19 Impact factor: 1.891
Authors: Rocío González-Márquez; Juan P Rodrigo; Jose Luis Llorente; Cesar Alvarez-Marcos; Juan P Díaz; Carlos Suárez Journal: Eur Arch Otorhinolaryngol Date: 2012-04-07 Impact factor: 2.503
Authors: Peter T Dziegielewski; Theodoros N Teknos; Kasim Durmus; Matthew Old; Amit Agrawal; Kiran Kakarala; Anna Marcinow; Enver Ozer Journal: JAMA Otolaryngol Head Neck Surg Date: 2013-11 Impact factor: 6.223