Transoral Laser Surgery for Glottic Carcinoma

Transoral laser surgery has emerged as a leading minimally invasive approach for the treatment of early glottic carcinoma, offering precise tumour excision with preservation of laryngeal structures and function. By employing a carbon dioxide or thulium laser delivered via a rigid endoscope, surgeons can achieve targeted resection of malignant lesions while minimising damage to surrounding healthy tissue. This technique permits excellent visualisation of the glottis and exact depth control, reducing peri-operative morbidity and enabling rapid recovery of voice and swallowing. Oncological outcomes for suitably selected Tis and T1 lesions are comparable with those of radiotherapy, with high rates of local control and overall survival. Moreover, transoral laser surgery affords the possibility of repeat intervention in cases of recurrence and avoids the cumulative toxicity of radiation. Advances in intraoperative imaging, margin assessment and functional rehabilitation have further refined patient selection and postoperative care, reinforcing the role of this approach in contemporary head and neck oncology.

Research from Nature Portfolio

A comprehensive systematic review and meta-analysis compared transoral laser surgery with radiotherapy in Tis and T1a glottic carcinoma, demonstrating significantly improved overall and disease-specific survival in patients undergoing laser resection. Laryngeal preservation rates were higher following surgery, with no compromise in local control. Functional voice assessments revealed mixed results: objective acoustic measures such as jitter and shimmer tended to favour radiotherapy, whereas patient-reported voice handicap indices and fundamental frequency exhibited no substantial difference. These findings support the preferential use of transoral laser surgery in eligible early glottic carcinomas, balancing oncological efficacy and functional outcomes.

Transoral Laser Surgery for Glottic Carcinoma publication trend

The graph below shows the total number of articles in transoral laser surgery for glottic carcinoma across all publications each year (not limited to Nature Index journals).

Technical terms

Transoral laser microsurgery: A surgical technique that uses focused laser energy delivered through an endoscope to excise lesions from the vocal folds.

Glottic carcinoma: A malignancy arising from the epithelial lining of the vocal fold (glottis), most often squamous cell in type.

Negative margin: Histological confirmation that no tumour cells are present at the resection edge, indicating complete excision.

Narrow-band imaging: An endoscopic technique that enhances visualisation of mucosal and submucosal vascular patterns to better delineate tumour boundaries.

Laryngeal preservation: The maintenance of structural integrity and function of the larynx following oncological treatment.

References

1. Management and Oncologic Outcomes of Close and Positive Margins after Transoral CO2 Laser Microsurgery for Early Glottic Carcinoma. Cancers (2023).
2. Comparison between transoral laser surgery and radiotherapy in the treatment of early glottic cancer: A systematic review and meta-analysis. Scientific Reports (2018).