Transoral laser microsurgery for oral squamous cell carcinoma: oncologic outcomes and prognostic factors

Head Neck. 2014 Mar;36(3):340-51. doi: 10.1002/hed.23293. Epub 2013 Jun 1.

Abstract

Background: Modest survival rates are published for treatment of oral squamous cell carcinoma (OSCC) using conventional approaches. Few cohort studies are available for transoral resection of OSCC.

Methods: Analysis for recurrence, survival, and prognosis of patients with OSCC treated with transoral laser microsurgery (TLM) ± neck dissection was obtained from a prospective database.

Results: Ninety-five patients (71 patients had stages T1-T2 and 24 had stages T3-T4 disease) with minimum follow-up of 24 months met criteria and demonstrated negative margins in 95%. Five-year local control (LC) and disease-specific survival (DSS) were 78% and 76%, respectively. Surgical salvage achieved an absolute final locoregional control of 92%. Immune compromise and final margins were prognostic for LC, whereas T classification, N classification, TNM stage, comorbidity, and perineural invasion were also significant for DSS.

Conclusion: We document a large series of patients with OSCC treated with TLM, incorporating T1 to T4 primaries. A significant proportion of stage III/IV cases demonstrates feasibility of TLM in higher stages, with final margin positivity of 5%, LC greater than 90%, and comparable survival outcomes.

Keywords: laser; oral cancer; survival; tongue; transoral microsurgery.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / surgery*
  • Female
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / surgery*
  • Humans
  • Laser Therapy / methods*
  • Lymph Node Excision
  • Male
  • Microsurgery / methods*
  • Middle Aged
  • Mouth Neoplasms / mortality
  • Mouth Neoplasms / surgery*
  • Neoplasm Recurrence, Local / surgery
  • Neoplasm Staging
  • Prognosis
  • Salvage Therapy
  • Squamous Cell Carcinoma of Head and Neck
  • Surgical Flaps
  • Survival Analysis