CO2 laser surgery: a larynx preservation alternative for selected hypopharyngeal carcinomas.

Background: Transoral CO2 laser surgery (TLS) has demonstrated good oncologic results and low morbidity in the treatment of selected laryngeal carcinomas, but experience in hypopharyngeal carcinomas (HC) is limited. The aim of this study was to evaluate the usefulness of TLS in the treatment of selected HC.

Methods: Twenty-eight patients with HC were treated with TLS and neck dissection. Tumors with preoperative invasion of thyroid cartilage at CT, deep growth into the cervical space or tongue base, and tumors crossing the posterior midline or involving the cervical esophagus were excluded. Postoperative radiation to the neck was administered when more than one lymph node was involved, when the metastasis diameter was greater than 2 cm, or when extranodal spread was found at the pathologic study.

Results: The sample included two T1, 16 T2, nine T3, and one T4 tumors. Stage classification was: II, 21.4%; III, 28.6%; and IV, 50%. Four-year overall and disease-specific survival rates were 43.4% and 59.4%, respectively, with 78.5% function preservation. Nine patients (32.1%) did not need a nasogastric feeding tube. The mean duration of the feeding tube in the remaining patients was 15.27 +/- 27.3 days. We had two postoperative bleeding episodes that required endoscopic coagulation and three postoperative pneumonias caused by aspiration.

Conclusions: TLS is an alternative for the treatment of selected HC associated with a high larynx preservation rate.