Evidenz und Evidenzlücken zur Chirurgie des Larynxkarzinoms

Zusammenfassung

Die operative Therapie von Larynxkarzinomen ist seit Jahrzehnten etabliert. Neben der Laryngektomie, die erstmals 1873 durchgeführt wurde, haben sich eine Vielzahl larynxerhaltender Operationstechniken, wie verschiedene offene Teilresektionen, die transorale Laserchirurgie und zuletzt die transorale Roboterchirurgie, entwickelt. Die am häufigsten angewendeten Studienformen in Studien zur Chirurgie des Larynxkarzinoms sind retrospektive Analysen von Fallserien, hiernach folgen Vergleiche von prospektiv geführten Erhebungen mit historischen Kontrollgruppen. Die Weiterentwicklung der Radio(chemo)therapieprotokolle und deren Analyse in prospektiven randomisierten Studien haben zu einer steigenden Akzeptanz nicht-chirurgischer Therapieverfahren geführt, auch aus dem Grund, dass prospektive kontrollierte randomisierte Studien als das Rückgrat der evidenzbasierten Medizin gelten. In den letzten Jahren rückt neben einer Verbesserung der Prognose von Patienten mit Larynxkarzinomen jedoch auch der möglichst umfassende Erhalt der Larynxfunktionalität nach Primärtherapie zunehmend in den Mittelpunkt der Therapieplanung. Die nicht unerheblichen Spättoxizitäten nach Radiochemotherapie wurden verstärkt analysiert. Dies führt zu einer Neubewertung primär chirurgischer Konzepte und Initiierung von Studien zur chirurgischen Therapie des Larynxkarzinoms, die auch durch die Hinwendung zur transoralen Roboterchirurgie in den USA gefördert werden. Durch Priorisierung erforderlicher chirurgischer Forschung sollte in Zukunft die Evidenzlage zur chirurgischen Therapie des Larynxkarzinoms verbessert werden.

Abstract

Surgical treatment of laryngeal cancer has been established for decades. In addition to total laryngectomy, which was first performed in 1873, a large number of organ preservation surgical techniques, like open partial laryngectomy, transoral laser microsurgery and transoral robotic surgery, have been developed. Studies on laryngeal cancer surgery are mainly retrospective case series and cohort studies. The evolution of chemoradiation protocols and their analysis in prospective randomized trials have led to an increasing acceptance of non-surgical treatment procedures. In addition to an improvement of prognosis, in recent years the preservation of function and maintenance of life quality after primary therapy of laryngeal cancer has increasingly become the focus of therapy planning. Significant late toxicity after chemoradiation has been identified as an important issue. This leads to a reassessment of surgical concepts and initiation of studies on laryngeal cancer surgery which was additionally stimulated by the advent of transoral robotic surgery in the U.S.. Improving the evidence base in laryngeal cancer surgery by successful establishment of surgical trials should be the future goal

Schlüsselwörter

Larynxkarzinom - Laryngektomie - Larynxteilresektion - transorale Laserchirurgie - transorale Roboterchirurgie

Key words

laryngeal cancer - laryngectomy - open partial laryngectomy - transoral laser surgery - transoral robotic surgery

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