The ideal treatment for malignant laryngeal tumors - in an earlier article I described what is laryngeal cancer, as well as its symptoms and diagnosis - is surgery and among the options that allow a preservation of the surgical organ highlights transoral laser microsurgery CO2 (carbonic). Basically, the therapeutic concept is that any tumor for which partial resection with preservation of organ seems possible, must be treated primarily with transoral laser microsurgery, with the visual aid of the surgical microscope.
The objective of transoral resection with the laser is the radical removal of the tumor , supported by the results of intraoperative biopsies, and the control of tumor extension by surgical microscope or laryngeal optics. There are still too many total laryngectomies in patients who may have been good candidates for treatment with preservation of the larynx.
Advantages of transoral laser microsurgery
Here are some of the advantages of transoral laser microsurgery over other treatments:
- Prevents healthy tissue resection
- Preserves structures that facilitate swallowing (sensitive nerves, musculature)
- Very low perioperative morbidity and mortality and low postoperative morbidity
- No reconstructive surgery required
- It can be repeated
- Avoid external incisions (less pain)
- Prevents total tracheotomies and laryngectomies
- Less intraoperative blood loss
- Lower hospital stay and reduction of treatment costs
- Possibility of integration into other models of therapeutic concept (radiotherapy or chemotherapy)
- Possibility of early initiation (2-3 weeks) of adjuvant radiotherapy
- Possibility to switch to open surgery, both in the first and second instance
- Less stress (patient, family and surgeon)
- Good rehabilitation of swallowing and voice
- Rapid family, social and work reintegration
- Easy endoscopic follow-up (except piriform sinus)
- Favorable psychological situation for the preservation of the organ
To guarantee the success of transoral surgery , especially when the intention is curative in advanced tumors, it is important to fulfill some prerequisites. Among other factors for a safe oncological resection with organ preservation, the surgeon's experience in the management of this technique and the good exposure of the tumor are essential to facilitate the identification of a healthy tissue margin. Comprehensive analysis of the margins by the pathologist is the basis of verification of a perfect resection. Compared with conventional surgery, transoral laser microsurgery, especially in large tumors, conducts further investigations of surgical margins.