Ergebnisse der transoralen Laserresektion bei T1-2 Karzinomen von Oropharynx, Hypopharynx und Larynx

Zusammenfassung

Hintergrund:

Die transorale mikroskopisch kontrollierte Laserchirurgie (TLM) hat zu einer Erweiterung der Behandlungsmöglichkeiten von Malignomen im Kopf-Hals-Bereich geführt. Ziele dieser Arbeit sind über die onkologischen Ergebnisse und den Funktionserhalt nach TLM bei frühen Karzinomen zu berichten.

Material und Methoden:

In einer retrospektiven Analyse wurden 946 Patienten, die zwischen 1979 und 2007 wegen eines T1-2 Karzinoms mittels TLM primär operiert wurden, untersucht. Das Überleben wurde in Abhängigkeit von Lokalisation, der T- und N-Klassifikation und dem R-Status analysiert. Zusätzlich wurden die wichtigsten Komplikationen und die postoperative Schluckfunktion ausgewertet.

Ergebnisse:

Das krankheitsspezifische 5-Jahres-Überleben betrug 78,6% für Oropharynxkarzinome, 68,9% für Hypopharynxkarzinome, 82,3% für supraglottische und 95,2% für glottische Karzinome. Patienten mit R0-Resektion und N0 Halsstatus zeigten eine signifikant bessere Prognose. Die Komplikationsrate war mit 4,7% niedrig. 1% der Patienten zeigten eine permanent gestörte Schluckfunktion, und bei 1,1% war eine permanente Tracheotomie notwendig.

Schlussfolgerung:

Die TLM ist eine sehr effektive Operationstechnik bei frühen Karzinomen in Kopf-Hals Bereich, sofern eine R0-Resektion erzielt wird. Gleichzeitig bietet die Methode gute funktionelle Ergebnisse und niedrige Komplikationsraten.

Abstract

Results of Transoral Laser Resection in T1-2 Oropharyngeal, Hypopharyngeal and Laryngeal Carcinomas

Background:

Transoral laser microsurgery (TLM) has led to an expansion of the therapeutic modalities for malignomas of head and neck. This study aims to assess the oncologic results and functional outcomes of TLM in early carcinomas.

Patients and Methods:

This is a retrospective study of 947 cases with T1-2 carcinomas primarily managed with laser surgery between 1979 and 2007. All cases were assessed for survival, with respect to location, T and N classification and status of surgical margins. Cases were additionally evaluated for incidence of major complications and retention of laryngeal and pharyngeal function.

Results:

Disease specific survival was 78.6% for oropharyngeal, 68.9% for hypopharyngeal, 82.3% for supraglottic und 95.2% for glottis carcinomas. Survival estimates were found to be significantly better for cases without cervical metastasis and with negative surgical margins. A low rate of major complications (4.7%) were noted. 1% of the patients had a permanent dysfunction of swallowing and 1.1% needed a permanent tracheostomy.

Conclusion:

Laser surgery appears to be a very effective management modality for small carcinomas of the head and neck as long as clear surgical margins can be achieved. This technique offers acceptable oncologic results with a low incidence of complications and satisfactory retention of function.

Schlüsselwörter

Kopf-Hals - Karzinome - Oropharynx - Hypopharynx - Larynx - Laser - CO2-Lasermikrochirurgie - Überleben - transoral

Key words

head and neck - carcinoma - oropharynx - hypopharynx - larynx - laser

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