title: Reasonable limits for transoral laser microsurgery in laryngeal cancer.
abstract: OBJECTIVE
  Transoral laser microsurgery (TLM) is widely acknowledged to offer several advantages in the treatment of early and selected intermediate-advanced laryngeal cancers. Nevertheless, a number of issues are still under debate. The purpose of this review is to discuss the reasonable limits for TLM in laryngeal cancer to highlight its most appropriate and reproducible indications, putting this therapeutic tool in the right perspective within a comprehensive frame of alternative treatment strategies such as open partial laryngectomies and nonsurgical organ preservation protocols.
  
  
  RESULTS
  Inadequate laryngeal exposure, anterior commissure involvement in the cranio-caudal plane (T2), invasion of the posterior paraglottic space with arytenoid fixation, massive infiltration of the preepiglottic space, and even minor thyroid cartilage erosion (T3) represent the most controversial applications of TLM in management of glottic and supraglottic cancer.
  
  
  CONCLUSIONS
  Published oncological results appear to be satisfactory when TLM is applied to T1-T2 and accurately selected T3 glottic and supraglottic cancers with favourable exposure. Caution should be used for more advanced tumours.
authors.affiliation: aDepartment of Otorhinolaryngology - Head and Neck Surgery, University of Genoa, GenoabDepartment of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Peretti
authors.forename: Cesare
authors.initials: C
authors.lastname: Piazza
authors.forename: Francesco
authors.initials: F
authors.lastname: Mora
authors.forename: Sabrina
authors.initials: S
authors.lastname: Garofolo
authors.forename: Luca
authors.initials: L
authors.lastname: Guastini
mesh_terms: D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods*; D008866:Microsurgery / Q000379:methods*