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Oropharynx
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Transoral laser microsurgery (TLM) and transoral robotic surgery are minimally invasive surgical techniques for T1–T3 tumours with considerably less long-term functional deficit than open surgery. TOS is usually performed with neck dissection, either simultaneously or as a staged procedure. Adjuvant treatment is required in most patients, usually due to advanced nodal disease.
Human Papillomavirus and Survival of Patients with Oropharyngeal Cancer
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
Advances in surgical technologies and techniques have offered the potential to explore treatment deintensification for surgically managed HPV-positive OPSCC with the aim of abrogating the functional and quality of life implications of primary CRT. Trials such as ECOG 33119 and PATHOS10 utilise transoral robotic surgery and/or transoral laser microsurgery for this purpose. On the basis of resective pathology including stage, nodal status, evidence of extracapsular spread (now termed extranodal extension), and surgical margins, these trials apply surgically based risk stratification, allocating patients to adjuvant therapy with randomisation in each arm including deintensified therapeutic alternatives.
Laryngeal tumours
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Philip Touska, Steve Connor, Robert Hermans
The available surgical procedures range from a limited excision to total laryngectomy (104). The expected findings after transoral laser microsurgery (TLM) depend on the amount of tissue resected. The laryngeal soft tissues may appear normal, show a small focal tissue defect, or demonstrate replacement of laryngeal soft tissue by scar tissue in more extensive resections. MRI is helpful in differentiating low T2 signal scar from recurrence in the latter case.
Predictive value of pathological carcinoma size in patients with T2 glottic laryngeal squamous cell carcinoma
Published in Acta Oto-Laryngologica, 2023
Jian Zhou, Xiaoke Zhu, Yue Yang, Liang Zhou, Hongli Gong, Chengzhi Xu, Lei Tao
All the patients underwent either partial or total laryngectomy based on the preoperative assessments of malignancy. Patients were diagnosed with SCC using the postoperative histopathological examination. Some patients with superficial injuries of the larynx and limited in-depth invasion of the anterior commissure and lateral visceral compartments were given transoral laser microsurgery (TLM). Most of the patients underwent vertical partial laryngectomy (VPL), cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP). Patients with significant cardiopulmonary comorbidities or at high risk of aspiration underwent total laryngectomy. The patients with positive surgical margins and close margins (≤2mm) were administered postoperative radiotherapy (PORT) ± chemotherapy. The specific scheme was described in the previous report [10].
Is there a role for ultrasonic surgery in transoral laryngeal cancer resections?
Published in Expert Review of Medical Devices, 2019
Giancarlo Tirelli, Nicoletta Gardenal, Annalisa Gatto, Pierluigi Bonini, Margherita Tofanelli, Mario Marcos Fernández-Fernández
When talking about laryngeal cancer, an essential issue of treatment other than survival must be the preservation of function. Surgeons can achieve this goal by means of open surgery and transoral surgery. Both of them should be based on the concept of a ‘tumor-tailored resection,’ following the actual tumor spread and using narrow margins to spare uninvolved structures and therefore improve functional outcome [1]. The most widespread transoral technique is transoral laser microsurgery (TLM). Thanks to recent advances in laser technology, TLM has been progressively employed in head and neck cancer and has become a preferred organ-preserving technique, initially for laryngeal cancer [2] but then for oral and pharyngeal cancers [3,4]. Nonetheless, this approach is not free from limitations. Among the concerns of TLM is the need for a continuous punctual coagulation of small bleedings during the resection and the inability to control moderate bleeding as the CO2 laser only coagulates vessels smaller than 0.5 mm [1].
Application of a thyroid cartilage window technique for transoral resection of early glottic cancer involving the anterior commissure
Published in Acta Oto-Laryngologica, 2021
Qingxiang Zhang, Xiaohong Chen, Shuangba He, Lifeng Li
Transoral laser microsurgery is a well-established treatment modality for early-stage glottic carcinomas, with the fantastic oncological and functional results and few complications [1]. By comparison with open laryngectomy, transoral laser surgery demonstrates rapid recovery and avoided the necessity of tracheostomy. However, the treatment strategy of early stage glottic carcinoma with involvement of the anterior commissure is still debatable [2,3], which also carries the risks of local or regional recurrence.