CLINICAL REVIEW David W. Eisele, MD, Section Editor TRANSORAL LASER SURGERY FOR SUPRAGLOTTIC CANCER Juan P. Rodrigo, MD, 1,2 Carlos Sua ´rez, MD, 1,2 Carl E. Silver, MD, 3 Alessandra Rinaldo, MD, 4 Petra Ambrosch, MD, 5 Johannes J. Fagan, MBChB, FCS(SA), MMed, 6 Eric M. Genden, MD, 7 Alfio Ferlito, MD, DLO, DPath, FRCS, FRCSEd, FRCS(Glasg), FRCSI, FHKCORL, FDSRCS, FRCPath, FASCP, MCAP 4 1 Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain 2 Instituto Universitario de Oncologı ´a del Principado de Asturias, Oviedo, Spain 3 Departments of Surgery and Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 4 Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy. E-mail: a.ferlito@uniud.it 5 HNO-Klinik der Universitat Go ¨ttingen, jetzt: Klinik fur Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie des Universitatsklinikum Schleswig-Holstein, Campus Kiel, Germany 6 Division of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa 7 Department of Otolaryngology–Head and Neck Surgery, The Mount Sinai Medical Center, New York, New York Accepted 13 November 2007 Published online 7 March 2008 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hed.20811 Abstract: The goal of treatment for supraglottic cancer is to achieve cure and to preserve laryngeal function. Organ preser- vation strategies include both endoscopic and open surgical approaches as well as radiation and chemotherapy. The chal- lenge is to select the correct modalities for each patient. Endo- scopic procedures should be limited to tumors that can be com- pletely visualized during diagnostic microlaryngoscopy. If com- plete resection can be achieved, the oncologic results of transoral laser surgery appear to be comparable to those of classic supraglottic laryngectomy. In addition, functional results of transoral laser resection are superior to those of the conven- tional open approach, in terms of the time required to restore swallowing, tracheotomy rate, incidence of pharyngocutaneous fistulae, and shorter hospital stay. The management of the neck remains of paramount importance, as survival of patients with supraglottic cancer depends more on cervical metastasis than on the primary tumor. Most authors advocate bilateral elective neck dissection. However, in selected cases (T1,T2 clinically negative [N0] lateral supraglottic cancers), ipsilateral selective neck dissection could be performed without compromising sur- vival. The authors conclude that with careful selection of patients, laser supraglottic laryngectomy is a suitable, and often the preferred, treatment option for supraglottic cancer. V V C 2008 Wiley Periodicals, Inc. Head Neck 30: 658–666, 2008 Keywords: transoral laser surgery; surgical technique; supra- glottic cancer; outcome; complications; treatment of the neck The objectives of surgery for early to moderately advanced supraglottic cancer are cure of the tumor with preservation of voice, deglutition, and an intact airway. Key principles must be adhered to when determining patient eligibility for a surgi- cal organ preservation approach. The eligibility of each patient is based on the site and the extent of tumor, not merely the T classification. Other fac- tors that should be considered are the age of the Correspondence to: A. Ferlito V V C 2008 Wiley Periodicals, Inc. 658 Transoral Laser Surgery for Supraglottic Cancer HEAD & NECK—DOI 10.1002/hed May 2008