Transoral Approach for Early Laryngeal Cancers

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.