Transoral CO2 laser microsurgery for early hypopharyngeal cancer: Still a viable option?

INTRODUCTION

Hypopharyngeal squamous cell carcinoma (HPSCC) is a highly aggressive malignancy with poor prognosis due to late-stage diagnosis and complex anatomical challenges. Advances in minimally invasive techniques, particularly transoral laser microsurgery (CO2TOLMS), have demonstrated promise in improving oncologic and functional outcomes while preserving organ function.

MATERIALS AND

METHODS

A retrospective study analyzed 25 patients with histologically confirmed HPSCC treated with CO2TOLMS at a tertiary academic hospital (2016-2021). Patients underwent curative-intent CO2TOLMS, with outcomes assessed for survival, recurrence, and functional recovery.

RESULTS

The 3-year overall survival and disease-specific survival rates were 72% and 84%, respectively. Surgical margins were disease-free in 76% of patients, while postoperative complications were minimal (persistent tracheostomy in 4%, long-term nasogastric feeding tube dependency in 4%). Local and regional recurrence rates were each 8%. Laryngeal preservation was achieved in 95% of cases, significantly enhancing quality of life. Histologic grade correlated with recurrence risk, though survival outcomes were consistent across tumor stages and surgical margin status.

CONCLUSIONS

CO2TOLMS offers an effective and minimally invasive treatment for early-stage HPSCC, achieving good oncological and functional outcomes. While it provides low morbidity and high organ preservation rates, further research is needed to refine multimodal treatment strategies for advanced-stage disease.