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. 2012:11:Doc05.
doi: 10.3205/cto000087. Epub 2012 Dec 20.

Transoral treatment strategies for head and neck tumors

Christoph Arens  1
Affiliations

Transoral treatment strategies for head and neck tumors

Christoph Arens. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2012.

Abstract

The introduction of transoral endoscopic surgery has initiated a fundamental change in the treatment of head and neck cancer. The endoscopic approach minimizes the intraoperative trauma. Due to the lower burden for the patient and the savings potential these methods have gained wide acceptance. These transoral accesses routes allow experienced surgeons to reduce the morbidity of surgical resection with no deterioration of oncologic results. This suggests a further extension of the indication spectrum and a high growth potential for these techniques and equipment in the coming years. For selected patients with selected tumors the minimally invasive transoral surgery offers improved oncological and functional results. In the present paper, different surgical access routes are presented and their indications discussed.

Keywords: endoscopy; laser; limits; minimally invasive surgical indications; transoral surgery.

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Figures

Table 1
Table 1. Meta-analysis T1–T2 vocal fold carcinoma (TES)
Table 2
Table 2. Meta-analysis T1–T2 supraglottic carcinoma (TES ± RT/RCT)
Table 3
Table 3. Meta-analysis T1–T2 hypopharyngeal carcinoma (TES ± RT/RCT)
Table 4
Table 4. Meta-analysis T1–T2 oropharyngeal carcinoma (TES ± RT/RCT)
Table 5
Table 5. Different transoral accesses and target organs
Figure 1
Figure 1. Different distendable laryngoscopes and surgical instruments for TES
Figure 2
Figure 2. Different endoscopes for TES. ENDOCAMELEON® is a new superior endoscope for intraoperative video documentation.
Figure 3
Figure 3. Carcinoma in situ of the left vocal fold. Microlaryngoscopical picture before and after cordectomy type I as a single stage treatment.
Figure 4
Figure 4. Right-sided T2 hypopharyngeal carcinoma preoperative
Figure 5
Figure 5. Intraoperative picture after TES of a right-sided T2 hypopharyngeal carcinoma
Figure 6
Figure 6. Figure 6: Surgical setting in the OR [157]: 1 DaVinci robotic system, 2 First surgeon at the console, 3 Second surgeon at the head of the patient, 4 Nurse at the instrument table, 5 Second table for DaVinci Robot applicators, 6 Videotower, 7 Anesthesiologist, 8 Monopolar/bipolar cautery
Figure 7
Figure 7. Laser incision in the vallecula with the DaVinci-robotic system. Resection of a tongue base tumor (G. Peretti, Brescia, Italy).
Figure 8
Figure 8. Dorsal view on the surgical field at the tongue base at the end of the resection using the DaVinci robotic system
Figure 9
Figure 9. Preparation of a mediastinal lymph node using a transoral access [158]
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