Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Robert-Koch-Str. 40, 37099 Göttingen, Germany.
Eur Arch Otorhinolaryngol. 2013 Aug;270(8):2315-26. doi: 10.1007/s00405-012-2327-6. Epub 2013 Jan 10.
The objective of the study was to evaluate the oncological and functional results of transoral laser microsurgery (TLM) in patients with supraglottic laryngeal squamous cell carcinoma. Between June 1980 and December 2006, 277 patients with squamous cell supraglottic carcinoma of all stages were treated by primary carbon dioxide laser microsurgery. All treatments were performed with curative intention. The goal was the complete tumor removal with preservation of functionally important structures of the larynx. The administered treatment was exclusively TLM with or without selective or modified radical neck dissection in 215 cases (78 %); TLM with postoperative radiotherapy was performed in 62 cases (22 %). Data were analyzed using the Kaplan-Meier method. The median follow-up was 65 months. We achieved a 5-year local control rate of 85% for pT1/pT2, 82% for pT3, and 76% for pT4. The 5-year overall, recurrence-free and disease-specific survival rates for stages I and II were 76, 81, and 92%, for stages III and IVa 59, 65, and 81%, respectively. With respect to local control and survival, these results are comparable with the results achieved by conventional partial and total resection of the larynx, while being superior to primary (chemo)radiotherapy. Transoral laser microsurgery results in a low morbidity, rapid recovery, and superior function compared with standard therapy.
本研究旨在评估经口激光显微手术（TLM）治疗声门上型喉鳞状细胞癌的肿瘤学和功能结果。1980 年 6 月至 2006 年 12 月期间，对 277 例各期声门上型喉鳞状细胞癌患者采用原发性二氧化碳激光显微手术进行治疗。所有治疗均以治愈为目的。治疗目标是在保留喉功能重要结构的前提下，完全切除肿瘤。所实施的治疗方法为单纯 TLM，或在 215 例（78%）患者中选择性或改良根治性颈部淋巴结清扫术，或在 62 例（22%）患者中术后行放疗。采用 Kaplan-Meier 法分析数据。中位随访时间为 65 个月。我们取得了 pT1/pT2 患者的 5 年局部控制率为 85%、pT3 患者为 82%、pT4 患者为 76%。Ⅰ期和Ⅱ期患者的 5 年总生存率、无复发生存率和疾病特异性生存率分别为 76%、81%和 92%，Ⅲ期和Ⅳa 期患者分别为 59%、65%和 81%。在局部控制和生存方面，这些结果与传统的部分和全喉切除术的结果相当，但优于单纯（化疗）放疗。与标准治疗相比，经口激光显微手术具有较低的发病率、较快的恢复和较好的功能。
