title: Complications in transoral CO2 laser surgery for carcinoma of the larynx and hypopharynx.
abstract: BACKGROUND
  Because of the increase in indications for laser surgery to treat malignant tumors of the larynx and hypopharynx, a higher number of complications may be expected. We prospectively evaluated the frequency and characteristics of intraoperative and postoperative complications of early and advanced tumors of the larynx and hypopharynx treated with CO(2) laser surgery and the potential influence of the surgical learning curve on the complication rate.
  
  
  METHODS
  Two hundred seventy-five patients operated in a tertiary referral center. Complications were classified either as major, requiring intensive medical treatment, blood transfusion, surgery, or ICU admission, or minor, resolving spontaneously or with conventional ambulatory treatment without sequelae. The surgical learning curve was analyzed by dividing the patients into two groups according to the date of surgery and then comparing the number of complications.
  
  
  RESULTS
  Complications occurred in 18.9% of patients; 9.8% were considered major and 9.1% minor. Complications included local infection (0.7%), emphysema (1%), cutaneous fistula (0.3%), postoperative bleeding (8%), airway ignition (0.3%), dyspnea (because of edema or stenosis) (1.8%), and swallowing difficulties or aspiration pneumonia (6.1%). The complication rate correlated significantly with tumor extension (p <.0001), the presence of diabetes mellitus (p =.01), and less surgical experience (p <.0001). Complications with severe sequelae occurred in two patients (p =.7).
  
  
  CONCLUSIONS
  Complications after transoral laser surgery of larynx and hypopharynx carcinomas are relatively frequent (18.9%), but serious sequelae and mortality rate are low. Complications are associated with tumor extension, limited surgical experience, and diabetes mellitus.
authors.affiliation: Department of Otorhinolaryngology, Hospital Clínic i Universitari de Barcelona, C/Villarroel 170, Barcelona 08036, Spain. ivilasecag@seorl.org
authors.forename: Isabel
authors.initials: I
authors.lastname: Vilaseca-González
authors.forename: Manuel
authors.initials: M
authors.lastname: Bernal-Sprekelsen
authors.forename: José-Luis
authors.initials: JL
authors.lastname: Blanch-Alejandro
authors.forename: Miguel
authors.initials: M
authors.lastname: Moragas-Lluis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery*; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007431:Intraoperative Complications; D007822:Laryngeal Neoplasms / Q000601:surgery*; D053685:Laser Therapy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies