Transoral Videolaryngoscopic Surgery for Laryngeal and Pharyngeal Cancer

Abstract

Transoral surgery is gaining importance as a minimally invasive treatment for laryngeal and pharyngeal cancer. We invented an original surgical technique of transoral videolaryngoscopic surgery (TOVS) using a distending laryngoscope, semi-rigid videolaryngoscope and 3-mm-diameter surgical forceps. Malleable devices have recently been introduced (grasping forceps, needle cautery, suction coagulator and Laser fiber) to facilitate approaching the marginal area of the endoscopic view. The benefits of this surgical system include a wide surgical view on the monitor, bimanual manipulation, en bloc resection, tactile sensation and cost effectiveness. The indications of TOVS are oropharyngeal, hypopharyngeal and supraglottic cancer with Tis, T1, T2 and selected T3 status. Selected radiorecurrent cancers （rT1 and rT2 lesion) are also included. Resectable nodal involvement can be managed by combination with neck dissection. Regarding the results of whole cases, the 5-year overall survival, disease-specific survival, local control rate and laryngeal preservation rate (hypopharyngeal and supraglottic cancer) were 80.6%, 88.4%, 90.4% and 94.8%, respectively. Postoperative radiotherapy or chemoradiotherapy was performed in 30% of cases. Surgical complications included emergency tracheostomy (2.3%), laryngeal edema managed by medical treatment (2.7%), bleeding (3.2%) and wound healing problems (2.7%). Regarding the post radiation status, any observed wound healing problems should be carefully managed. Chronic dysphagia (FOSS more than 3) occurred in 5.5% of cases. Arytenoid resection, a wide resection area and an older patient age are the risk factors for postoperative swallowing problems.