Original Research—Head and Neck Surgery Functional Outcomes after Salvage Transoral Laser Microsurgery for Laryngeal Squamous Cell Carcinoma Otolaryngology– Head and Neck Surgery 2016, Vol. 155(4) 606–611 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599816648111 http://otojournal.org Daniel S. Fink, MD 1,2 , Haley Sibley 1 , Melda Kunduk, CCC-SLP, PhD 1,2,3 , Mell Schexnaildre, CCC-SLP 2 , Collin Sutton, MD 1 , Anagha Kakade-Pawar, MSC, DBM, PDCR 4 , and Andrew J. McWhorter, MD 1,2 No sponsorships or competing interests have been disclosed for this article. Abstract Objectives. Transoral laser microsurgery (TLM) has been increasingly used in lieu of total laryngectomy to treat malig- nancy after definitive radiation. There are few data in the lit- erature regarding functional outcomes. We retrospectively reviewed voice and swallowing outcomes in patients who underwent TLM for recurrent laryngeal carcinoma. Study Design. Case series with chart review. Setting. Tertiary care center. Subjects and Methods. Forty-two patients were identified with recurrent squamous cell carcinoma of the larynx after definitive radiation therapy from 2001 to 2013: 28 patients with glottic recurrence and 14 with supraglottic recurrence. Swallowing out- comes were evaluated by gastrostomy tube dependence, the MD Anderson Dysphagia Inventory, and the Functional Oral Intake Scale. Voice outcomes were evaluated by the Voice Handicap Index and observer-rated perceptual analysis. Results. No significant difference was noted between mean pre- and postoperative MD Anderson Dysphagia Inventory scores: 78.25 and 74.9, respectively (P = .118, t = 1.6955). Mean Functional Oral Intake Scale scores after TLM for supraglottic and glottic recurrences were 6.4 and 6.6, respec- tively. Of 42 patients, 17 (40.5%) required a gastrostomy tube either during radiation or in conjunction with the salvage pro- cedure. Of 17 patients, 15 resumed sufficient oral diet for tube removal. Patients’ mean Voice Handicap Index score did increase from 34.3 to 51.5 (P = .047), and their mean percep- tual score did decrease from 60.0 to 45.3 (P = .005). However, at 1-year follow-up, there was no significant differ- ence in perceptual score: 61.1 to 57.1 (P = .722). Conclusions. TLM is a successful surgical option for recurrent laryngeal cancer with acceptable functional outcomes. Keywords TLM, salvage, larynx cancer, voice, dysphagia Received November 22, 2015; revised April 8, 2016; accepted April 14, 2016. L aryngeal squamous cell carcinoma may be treated sur- gically with total laryngectomy, open laryngeal conser- vation surgery, transoral laser microsurgery (TLM), or definitive radiotherapy. The use of CO 2 lasers to resect laryn- geal cancers endoscopically was first described by Strong and Jako. 1 Steiner further advanced this work by demonstrating TLM to be a viable alternative to radiotherapy. 2,3 An analysis of SEER data (Surveillance, Epidemiology, and End Results) on the treatment of early supraglottic squamous cell carcinoma revealed that patients who underwent organ preservation sur- gery with neck dissection had better overall survival and disease-specific survival than patients undergoing definitive radiotherapy alone. 4 TLM is therefore considered to be a sound oncologic procedure in the treatment of early glottic and supraglottic carcinoma. Functional outcomes are comparable in terms of voice and may be better in terms of swallowing, morbidity, and complication rates as compared with those reported for open laryngeal conservation surgery and radiotherapy. 5 Patients with recurrent disease after definitive radiation therapy pose a unique treatment dilemma. Traditionally, these patients have undergone salvage surgery in the form of total laryngectomy or open conservation laryngeal surgery. While both procedures have proven to be oncologically 1 Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA 2 Our Ladyof the Lake Voice Center, Baton Rouge, Louisiana, USA 3 Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana, USA 4 Merial Limited, North Brunswick, New Jersey, USA This article was presented at the 2015 AAO-HNSF Annual Meeting & OTO EXPO; September 27-30, 2015; Dallas, Texas. Corresponding Author: Daniel S. Fink, MD, Department of Otorhinolaryngology, Louisiana State University Health Sciences Center, 533 Bolivar St, Ste 566, New Orleans, LA 70112, USA. Email: dfink1@lsuhsc.edu at SOCIEDADE BRASILEIRA DE CIRUR on October 5, 2016 oto.sagepub.com Downloaded from