Laser Microsurgery for Laryngeal Tumors and Cancer
In most of the last century, patients who developed cancer on their larynx (voice box) usually required radical surgical approaches such as a total laryngectomy, which removed the voice box and permanently separated the windpipe and lungs from the patient’s nose and mouth. Breathing and speaking had to be done through an opening in the neck called a stoma.
In an effort to preserve voice and improve patient's quality of life, physicians began to adopt new technology to treat laryngeal tumors and cancer. Radiation therapy combined with chemotherapy was one option that began to be used. Though radiation treatment is very powerful and effective in treating cancer, the function of the voice box is compromised to various degrees in different individuals. Some patients may become dependent on feeding tubes and tracheostomy tubes. People who fail radiation treatment often go on to need radical surgery such as total laryngectomy.
It became apparent that early cancers and tumors may benefit from treatment that preserves the natural function of the larynx (voice box) while conserving radiation treatment if the need arises. Minimally invasive transoral laser microsurgery has developed to be an effective option for patients with early cancers and tumors of the larynx.
Surgeons at Coastal Ear, Nose and Throat are using both cutting (CO2) and photoangiolytic (KTP) lasers to treat patients with cancers and tumors of the larynx. Each laser has its own merit. The CO2 laser targets water and is useful for cutting tissue and controlling bleeding at the same time. The CO2 laser is ideal for large endoscopic resections and endoscopic treatment of airway stenosis (airway narrowing).
The photoangiolytic KTP laser is distinct in its ability to target abnormal tissues (cancers and tumors) that have more network of blood vessels. So normal tissue with normal vascularity is preserved. For cancers and tumors of the vocal cord this is especially relevant because vocal function is directly related to how much normal vibratory tissue is preserved to give patients a good voice.
Moreover, the KTP laser is fiber-guided and can be used to do awake endoscopic laser surgeries for benign neoplasms such as recurrent respiratory papillomatosis (RRP) and precancerous vocal cord changes like dysplasia. Respiratory papillomatosis is unique in its ability to recur unpredictably. Patients with RRP can avoid general anesthesia and have laser treatment done while sitting awake.
Lastly, surgeons at Coastal Ear, Nose and Throat complement their endoscopic approaches with open approaches when necessary to treat cancers and tumors of the larynx. Expertise in both surgical approaches give patients a comprehensive treatment plan to cure cancer and preserve function of the larynx. Cases are discussed in multidisciplinary head and neck cancer tumor board to coordinate care for patients who require speech and swallow rehabilitation, chemotherapy, radiation therapy, and social work.