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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 transoral laser surgery in a multimodality treatment regimen with neck dissection and postoperative irradiation in advanced laryngeal carcinomas. Patients and Methods: From June 1993 to December 1996 we examined 40 patients (32 men, 8 women; mean age 59 years) with advanced laryngeal squamous cell carcinomas (stages III and IV: 95%, stage II: 5%) who underwent a multimodality treatment regimen with transoral laser surgery, bilateral neck dissection, and postoperative irradiation. Median follow-up time was 39 months. Results: The 3-year overall survival rate was 85%. The local and regional recurrence rates were 37.5 and 27.5%, respectively. Postoperative complications which were related to the laser surgical intervention occurred in 5 patients (12.5%). Conclusions: The oncological results of transoral CO2 laser surgery combined with bilateral neck dissection and postoperative irradiation are satisfying if clean surgical tumor margins (R0) can be reached. In patients in whom tumor-free margins are not achieved (R1 and R2 resections) and transoral revision is not possible, transcervical procedures (total or partial 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 modalities which include radical laryngectomy.