Complications in CO₂ Laser Transoral Microsurgery for Larynx Carcinomas

Abstract

Introduction Transoral laser microsurgery (TLM) has established itself as an effective option in the management of malignant tumors of the glottis, supraglottis, and hypopharynx. Nonetheless, TLM is not a harmless technique. Complications such as bleeding, dyspnea, or ignition of the air may appear in this type of surgery.

Objective The aim of this study is to describe the complications that occurred in a group of patients treated for glottic and supraglottic carcinomas in all stages by TLM.

Methods This study is a retrospective analysis of patients diagnosed with squamous cell carcinoma of the glottis and supraglottis for all stages (T1, T2, T3, T4), N -/ + , M -/+ treated with TLM between January 2009 and March 2012 in a tertiary hospital.

Results Ninety-eight patients met the inclusion criteria, which had undergone a total of 131 interventions. Ninety-four (95.9%) patients were male and 4 (4.1%) were female. The mean age was 64.2 years (± 10.7 years = min 45; max 88). The presence of intraoperative complications was low, affecting only 2% of patients. Immediate postoperative complications occurred in 6.1%, whereas delayed complications affected 13.2% of patients, without any of them being fatal.

Conclusion TLM has shown good oncologic results and low complication rate compared with traditional open surgery during intervention, in the immediate and delayed postoperative period and in the long-term with respect to radiotherapy.

Keywords

complications - CO₂ laser - larynx - carcinoma

• References

• 1 Strong MS, Jako GJ. Laser surgery in the larynx. Early clinical experience with continuous CO 2 laser. Ann Otol Rhinol Laryngol 1972; 81 (6) 791-798
• 2 Strong MS. Laser excision of carcinoma of the larynx. Laryngoscope 1975; 85 (8) 1286-1289
• 3 Vilaseca-González I, Bernal-Sprekelsen M, Blanch-Alejandro JL, Moragas-Lluis M. Complications in transoral CO2 laser surgery for carcinoma of the larynx and hypopharynx. Head Neck 2003; 25 (5) 382-388
• 4 Stoeckli SJ, Schnieper I, Huguenin P, Schmid S. Early glottic carcinoma: treatment according patient's preference?. Head Neck 2003; 25 (12) 1051-1056
• 5 Steiner W, Ambrosch P. Advantages of transoral laser microsurgery over standard therapy. In: Endoscopic laser surgery of the upper aerodigestive tract. Stuttgart: Georg Thieme Verlag; 2000: 44-45
• 6 Remacle M, Van Haverbeke C, Eckel H , et al. Proposal for revision of the European Laryngological Society classification of endoscopic cordectomies. Eur Arch Otorhinolaryngol 2007; 264 (5) 499-504
• 7 Remacle M, Hantzakos A, Eckel H , et al. Endoscopic supraglottic laryngectomy: a proposal for a classification by the working committee on nomenclature, European Laryngological Society. Eur Arch Otorhinolaryngol 2009; 266 (7) 993-998
• 8 Steiner W, Ambrosch P. Complications. In: Endoscopic laser surgery of the upper aerodigestive tract. Stuttgart: Georg Thieme Verlag; 2000: 112-113
• 9 Peretti G, Piazza C, Ansarin M , et al. Transoral CO2 laser microsurgery for Tis-T3 supraglottic squamous cell carcinomas. Eur Arch Otorhinolaryngol 2010; 267 (11) 1735-1742
• 10 Remacle M, Lawson G, Hantzakos A, Jamart J. Endoscopic partial supraglottic laryngectomies: techniques and results. Otolaryngol Head Neck Surg 2009; 141 (3) 374-381
• 11 Canis M, Martin A, Ihler F , et al. Results of transoral laser microsurgery for supraglottic carcinoma in 277 patients. Eur Arch Otorhinolaryngol 2013; 270 (8) 2315-2326
• 12 Prgomet D, Bacić A, Prstacić R, Janjanin S. Complications of endoscopic CO2 laser surgery for laryngeal cancer and concepts of their management. Coll Antropol 2013; 37 (4) 1373-1378
• 13 Ellies M, Steiner W. Peri- and postoperative complications after laser surgery of tumors of the upper aerodigestive tract. Am J Otolaryngol 2007; 28 (3) 168-172
• 14 Roh JL, Kim DH, Park CI. Voice, swallowing and quality of life in patients after transoral laser surgery for supraglottic carcinoma. J Surg Oncol 2008; 98 (3) 184-189
• 15 Bernal-Sprekelsen M, Vilaseca-González I, Blanch-Alejandro JL. Predictive values for aspiration after endoscopic laser resections of malignant tumors of the hypopharynx and larynx. Head Neck 2004; 26 (2) 103-110
• 16 Olthoff A, Ewen A, Wolff HA , et al. Organ function and quality of life after transoral laser microsurgery and adjuvant radiotherapy for locally advanced laryngeal cancer. Strahlenther Onkol 2009; 185 (5) 303-309
• 17 Preuss SF, Cramer K, Klussmann JP, Eckel HE, Guntinas-Lichius O. Transoral laser surgery for laryngeal cancer: outcome, complications and prognostic factors in 275 patients. Eur J Surg Oncol 2009; 35 (3) 235-240
• 18 Ambrosch P. The role of laser microsurgery in the treatment of laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 2007; 15 (2) 82-88
• 19 Fried MP. Complications of CO2 laser surgery of the larynx. Laryngoscope 1983; 93 (3) 275-278