title: Transoral laser microsurgery for locally advanced (T3-T4a) supraglottic squamous cell carcinoma: Sixteen years of experience.
abstract: Controversy exists regarding treatment of advanced laryngeal cancer. The purpose of this study was to evaluate the oncologic and functional outcomes of T3 to T4a supraglottic squamous carcinomas treated with transoral laser microsurgery (TLM).
  
  
  
  We conducted a retrospective analysis from an SPSS database. Primary outcomes were: locoregional control, overall survival (OS), disease-specific survival (DSS), laryngectomy-free survival, and function-preservation rates. Secondary objectives were: rate of tracheostomies and gastrostomies according to age. Risk factors for local control and larynx preservation were also evaluated.
  
  
  
  One hundred fifty-four consecutive patients were chosen for this study. Median follow-up was 40.7 + /- 32.8 months. Five and 10-year OS, DSS, and laryngectomy-free survival were 55.6% and 47%, 67.6% and 58.6%, and 75.2% and 59.5%, respectively. Paraglottic involvement was an independent factor for larynx preservation. Six patients (3.9%) needed a definitive tracheostomy, a gastrostomy, or both. The gastrostomy rate was higher in the group of patients above 65 years of age (p = .03). Five-year laryngectomy-free survival with preserved function was 74.5%.
  
  
  
  TLM constitutes a true alternative for organ preservation in locally advanced supraglottic carcinomas with good oncologic and functional outcomes. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1050-1057, 2016.
authors.affiliation: Department of ORL-HNS, Hospital Clínic, Barcelona, Spain.|ENT Surgical Oncology Section, Hospital Clínic, Barcelona, Spain.|University of Barcelona Medical School, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Vilaseca
authors.affiliation: Department of ORL-HNS, Hospital Clínic, Barcelona, Spain.|ENT Surgical Oncology Section, Hospital Clínic, Barcelona, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Blanch
authors.affiliation: Neuroradiology Section, Department of Radiology, Hospital Clínic, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Berenguer
authors.affiliation: Department of Medical Oncology, Hospital Clínic, Barcelona, Spain.|University of Barcelona Medical School, Barcelona, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Grau
authors.affiliation: Department of Radiation Oncology, Hospital Clínic, Barcelona, Spain.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Verger
authors.affiliation: Department of Nuclear Medicine, Hospital Clínic, Barcelona, Spain.
authors.forename: África
authors.initials: Á
authors.lastname: Muxí
authors.affiliation: Department of ORL-HNS, Hospital Clínic, Barcelona, Spain.|University of Barcelona Medical School, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Bernal-Sprekelsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005931:Glottis / Q000473:pathology / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods; D053685:Laser Therapy / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: advanced laryngeal carcinoma; head neck cancer; squamous cell carcinoma; supraglottic carcinoma; transoral laser microsurgery