Transoral Laser Microsurgery in Carcinomas of the Oral Cavity, Pharynx, and Larynx

Jochen A. Werner, MD, Anja A. Dünne, MD, Benedikt J. Folz, MD, Burkard M. Lippert, MD

Disclosures

Cancer Control. 2002;9(5) 

In This Article

Abstract

Background: Since the introduction of laser technology in the 1960s, use of the technique in treating laryngeal diseases has demonstrated several advantages over conventional resections in selected cases.
Methods: The authors review the published data on oncologic laser surgery for the treatment of head and neck carcinomas, and they also describe their own clinical experience with transoral laser surgery for the treatment of carcinomas of the oral cavity, pharynx, and larynx.
Results: Laser surgery has achieved a key position in minimally invasive treatment concepts in the ears, nose, and throat area, especially for the treatment of malignancies of the upper aerodigestive tract. The CO2 laser is the approach most commonly used.
Conclusions: New and improved applications of laser therapy in the treatment of cancer are being explored. As more surgeons become experienced in the use of lasers and as our knowledge of the capabilities and advantages of this tool expands, lasers may play a larger role in the management of head and neck cancers.

Introduction

The word laser is an acronym for light amplification by stimulated emission of radiation. Since their development in 1960, lasers as surgical tools have evolved and now play an important role in the diagnosis and treatment of cancer. Laser treatment is more precise, decreases the change of infection, and reduces healing time, bleeding, swelling, and scarring. Several laser systems, such as the diode, ruby, Ho:YAG, Er:YAG, Nd:YAG, and yellow light lasers, as well as dye lasers for photodynamic therapy, have been used for treating various diseases. However, the argon and CO2 lasers were the first laser systems to be clinically used in the treatment of otorhinolaryngology. The CO2 laser currently has the greatest significance in otorhinolaryngology, predominantly in the treatment of carcinomas of the upper aerodigestive tract.

Strong and Jako[1] introduced the CO2 laser into microsurgery of the larynx in the early 1970s. The CO2 laser was increasingly utilized in the 1980s in the treatment of benign lesions in the larynx, particularly recurrent laryngeal papillomatosis. However, lasers were introduced more slowly in the treatment of malignancies and were restricted to only a few centers throughout the world. Furthermore, the application of lasers was mostly limited to the excision of early vocal cord tumors. The first reports of the successful use of lasers in cancer surgery were published in 1975.[2] Their guidelines regarding the indications of laser tumor surgery were carefully followed, with few alterations. Burian and Höfler were the first in Europe to successfully treat a glottic carcinoma with the laser.[3] As early as the beginning of the 1980s, Steiner[1] expanded the indications for curative laser treatment to all regions and all tumor types. This expansion was based on the excellent results obtained with both the microsurgical laser resection of early tumors and the palliation of advanced disease. Meanwhile, laser surgery achieved a key position in minimally invasive treatment concepts in the ears, nose, and throat (ENT) area, especially for the treatment of malignancies of the upper aerodigestive tract. In advanced cases, the primary aim of laser surgery is organ preservation.[1]

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