Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale · 2011
Review of transoral laser microsurgery for cancer of the upper aerodigestive tract.
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Rigby Matthew H, Taylor S Mark
Аннотация
OBJECTIVE: There is increasing evidence to support the role of transoral laser microsurgery (TLM) in treating cancers of the upper aerodigestive tract. The article summarizes our experience with TLM and reviews the evidence for TLM as a treatment modality for glottic, supraglottic, and oropharyngeal cancers. Functional results, the role of margins, and postoperative complications are also discussed in relation to TLM.
METHODS: MEDLINE reviews were performed to identify experimental or observational studies of outcomes for upper aerodigestive tract cancers treated by TLM. The references of relevant articles were used to identify any studies not detected by initial searches.
RESULTS: Over 300 articles were identified relating to outcomes in upper aerodigestive tract cancers treated with TLM. The overwhelming majority of these articles are observational rather than experimental studies.
CONCLUSIONS: The efficacy of TLM has been demonstrated for a broad spectrum of upper aerodigestive tract cancers. The best evidence to date supporting TLM comes from prospective cohort series and retrospective cohort comparisons. In early glottic cancer, there is increasing evidence suggesting that a shift toward the use of TLM as the primary treatment modality is oncologically and functionally sound and will provide cost savings. There is significantly less evidence to promote the widespread use of TLM in advanced glottic, supraglottic, and oropharyngeal cancers. However, for indications where outcomes appear similar, the cost benefits of TLM combined with the ability to use radiation as a salvage modality make strong arguments in favour of using TLM as the primary modality.
METHODS: MEDLINE reviews were performed to identify experimental or observational studies of outcomes for upper aerodigestive tract cancers treated by TLM. The references of relevant articles were used to identify any studies not detected by initial searches.
RESULTS: Over 300 articles were identified relating to outcomes in upper aerodigestive tract cancers treated with TLM. The overwhelming majority of these articles are observational rather than experimental studies.
CONCLUSIONS: The efficacy of TLM has been demonstrated for a broad spectrum of upper aerodigestive tract cancers. The best evidence to date supporting TLM comes from prospective cohort series and retrospective cohort comparisons. In early glottic cancer, there is increasing evidence suggesting that a shift toward the use of TLM as the primary treatment modality is oncologically and functionally sound and will provide cost savings. There is significantly less evidence to promote the widespread use of TLM in advanced glottic, supraglottic, and oropharyngeal cancers. However, for indications where outcomes appear similar, the cost benefits of TLM combined with the ability to use radiation as a salvage modality make strong arguments in favour of using TLM as the primary modality.