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Transoral Approach for Early Laryngeal Cancers

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Textbook of Surgery of Larynx and Trachea

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Abstract

Transoral laser microsurgery (TOLMS) is a widely used surgical approach for treating early glottic and supraglottic carcinomas. It is generally accepted that, in selected patients, it leads to oncological results comparable to other treatment modalities, while treatment-related morbidity is significantly reduced and functional outcomes are equal, if not better, in the long run. A thorough preoperative workup is mandatory before TOLMS and should involve transnasal videolaryngoscopy with the adjunction of bioendoscopic techniques like narrowband imaging, videolaryngostroboscopy, intraoperative rigid telescope evaluation, and, in selected cases, radiologic imaging. TOLMS usually involves the use of a carbon dioxide laser coupled to a surgical microscope through a suspended laryngoscope under general anesthesia. Tumor removal can be carried out en bloc or by serial and oriented piecemeal resections in case of bulkier tumors. A close follow-up is mandatory after this kind of narrow-margin conservative surgery. TOLMS procedures have been categorized by the European Laryngological Society classifications and, consequently, transoral approaches for laryngeal carcinoma are now standardized and lead to reproducible results in the hands of trained surgeons. However, tumors with an anterior transcommissural extension and/or impaired vocal fold mobility should be managed carefully by TOLMS and referred only to highly experienced centers.

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Change history

  • 10 February 2023

    The last name of Pamela Dela Cruz was unfortunately published as P. D. Cruz instead of P. Dela Cruz. This error has now been corrected.

Abbreviations

AC:

Anterior commissure

CT:

Computed tomography

ELS:

European Laryngological Society

MR:

magnetic resonance

NBI:

Narrowband imaging

OPHL:

Open partial horizontal laryngectomies

RT:

Radiotherapy

SCC:

Squamous cell carcinoma

SI:

Saline infusion

TOLMS:

Transoral laser microsurgery

VLS:

Videolaryngostroboscopy

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Authors and Affiliations

  1. Department of Otolaryngology—Head and Neck Surgery, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy

    Cesare Piazza

  2. Department of Oto-Rhino-Laryngology, A.ö. Landeskrankenhaus Klagenfurt, HNO, Klagenfurt, Austria

    Hans Edmund Eckel

  3. Department of Oto-Rhino-Laryngology, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg

    Marc Remacle

  4. Department of Otorhinolaryngology, Philippine General Hospital, University of the Philippines, Metro Manila, Philippines

    Pamela Dela Cruz

  5. Department of Otolaryngology—Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy

    Giorgio Peretti & Claudio Sampieri

Authors
  1. Cesare Piazza
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  2. Hans Edmund Eckel
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  3. Marc Remacle
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  4. Pamela Dela Cruz
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  5. Giorgio Peretti
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  6. Claudio Sampieri
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Corresponding author

Correspondence to Cesare Piazza .

Editor information

Editors and Affiliations

  1. Department of Oto-Rhino-Laryngology, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg

    Marc Remacle

  2. Department of Oto-Rhino-Laryngology, A.ö. Landeskrankenhaus Klagenfurt, HNO, Klagenfurt, Austria

    Hans Edmund Eckel

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Piazza, C., Eckel, H.E., Remacle, M., Dela Cruz, P., Peretti, G., Sampieri, C. (2022). Transoral Approach for Early Laryngeal Cancers. In: Remacle, M., Eckel, H.E. (eds) Textbook of Surgery of Larynx and Trachea. Springer, Cham. https://doi.org/10.1007/978-3-031-09621-1_24

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