Preliminary oncological results of a multimodality treatment regimen with transoral laser surgery, neck dissection and postoperative irradiation in advanced laryngeal carcinomas

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 t ransoral laser surgery in a multimodality treatment regimen with neck disse ction and postoperative irradiation in advanced laryngeal carcinomas. Patie nts and Methods: From June 1993 to December 1996 we examined 40 patients (3 2 men, 8 women; mean age 59 years) with advanced laryngeal squamous cell ca rcinomas (stages III and IV: 95%, stage II: 5%) who underwent a multimodali ty treatment regimen with transoral laser surgery, bilateral neck dissectio n, and postoperative irradiation. Median follow-up time was 39 months. Resu lts:The 3-year overall survival rate was 85%. The local and regional recurr ence rates were 37.5 and 27.5%, respectively. Postoperative complications w hich were related to the laser surgical intervention occurred in 5 patients (12.5%). Conclusions:The oncological results of transoral CO2 laser surger y combined with bilateral neck dissection and postoperative irradiation are satisfying if clean surgical tumor margins (R0) can be reached. In patient s in whom tumor-free margins are not achieved (R1 and R2 resections) and tr ansoral revision is not possible, transcervical procedures (total OF partia l 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 m odalities which include radical laryngectomy.