抄録
For preservation of laryngeal function with laryngeal cancer patients, the treatments of choice are (chemo) radiotherapy or partial laryngectomy. Recently chemoradiotherapy is performed in many cases; however, surgical treatments are required particularly with cases involving young patients, for tumors with poor radiosensitivity or with patients with a prior history of radiotherapy on the neck.
Surgical partial laryngectomies are divided into two approaches: open neck and transoral. With the transoral approach, laser microsurgery is an established treatment for laryngeal preservation and is a less invasive treatment; however, the surgical view through microscope is narrow and when blockwise resections are performed, then pathological evaluation is difficult. For transoral en bloc resection of supraglottic cancer, we used a distending laryngoscope with a rigid video-endoscope and laparoscopic surgical instruments. The combination of the distending laryngoscope and the rigid video-endoscope gave us a wide view of the operative field and facilitated bimanual manipulation by allowing a wide working space.
In our institution, the same surgical technique could be applied for T1, T2 and a part of T3 supraglottic cancer(n=9)and hypopharyngeal cancer (n=21). Recovery of postoperative swallowing function, the tracheostomy rate, the number of surgical complications, and survival outcomes were evaluated. These results were compared with previous cases treated with open neck surger (n=28). In comparison with open neck surgery, transoral surgery could quicken swallowing recovery, reduce tracheostomy and complication rate, and maintain an equivalent survival outcome.
