Wolfgang Steiner – The Evidence for Change in the Management of Laryngeal and Hypopharyngeal Cancer

Written by Wolfgang Steiner

The observation that in small vocal cord lesions (Ca.i.s., Micro carcinoma) diagnostic excisional biopsy was very often curative – as proved by histology after open surgery – was the main rationale for endoscopic surgery with curative intent. The oncological and functional results were convincing. This was the start for the most cost-effective treatment of early cancer.

Later it has been shown that transoral laser microsurgical resection is an efficient alternative treatment to open surgery for moderately advanced tumours. The oncological results were similar, the functional results better, the morbidity (no tracheotomy, no feeding tube) lower. The surgical strategy is not only based on and determined by the preoperative findings, but the transoral resection rather follows the individual spread of the tumour as seen under the microscope as a custom tailored surgery. The principle is to minimise the surgical morbidity while not compromising time honoured oncological principles. Thanks to the specific cutting properties of the CO2 laser and the high magnification of the microscope as well the transoral approach and the unconventional technique of blockwise resection of larger lesions, the tumour can be removed safely with preservation of functional important structures.

Advantages in comparison to standard therapy are: free option for any kind of surgery, laser surgery can be repeated at any time, integration into any therapeutic concept, no reconstructive surgery necessary, low peri- and postoperative morbidity and low rate of complications and – last but not least – reduced costs, faster and more complete reintegration in work and social life, improved psychological situation. Gaining more experience even more advanced tumours can be treated transorally with organ preservation, if the exposure is adequate. According to our long term results transoral laser resection is much more effective than any organ preserving therapeutic regime.