Treatment of laryngeal cancer mainly consists of radiation therapy, chemoradiotherapy and surgery. For organ preservation surgery, transoral surgery or open partial laryngectomy are the treatments of choice. Of these, transoral surgery is the least invasive, allowing for a direct approach to the lesions. In our institution, we practice two modalities for transoral surgery. Transoral laser microsurgery (TLM) is indicated for glottic cancer, which has a narrow working space. In contrast, transoral videolaryngoscopic surgery (TOVS) is indicated for supraglottic cancer, since the working space is relatively wide and the lesion can be visualized from various directions using a laryngeal endoscope. In glottic initial cases (Tis, T1-2 and 1 case of T3), the 5-year overall survival (OS), disease-specific survival (DSS), larynx preservation rate (LPR), local control rate (LCR) and laryngoesophageal dysfunction-free survival (LEDFS) were 90.3%, 95.7%, 95.1%, 78.5% and 75.2%, respectively. Good oncological results can be expected in Tis, T1-T2 glottic cancer; however, T1b cases are not a good indication for TLM because of the high incidence of glottic web formation. In radiorecurrent salvage TLM for rT1-rT2 lesion, the 5-year OS, DSS, LPR, LCR and LEDFS were 86.2%, 91.3%, 83.9%, 71.8% and 67.3%, respectively. Acceptable oncological results were obtained for rT1-rT2 lesions. A relatively large surgical margin is recommended in radiorecurrent cancer. In supraglottic cancer with T1-T3 lesions, the 5-year OS, DSS, LPR, LCR and LEDFS were 73.0%, 88.2%, 89.4%, 88.1% and 67.3%, respectively. A good organ preservation rate was achieved, and the swallowing function was preserved except for in one case. Considering the laryngeal cancer treatment guidelines, T1-T2 and rT1-rT2 lesions can be indicated for transoral surgery, and in experienced institutions, select T3 lesion can also be indicated for transoral surgery.
