[Endolaryngeal laser surgery in the treatment of laryngeal cancers. The current Cologne concept]

Abstract

Tumors can be resected in two different ways using endolaryngeal laser surgery. 1. After taking a biopsy from the lesion for histological purposes, the remaining tumor is completely vaporized. This method is only to be used in the treatment of premalignant lesions, as it does not allow a clear histological examination of the boundaries of such lesions. 2. The laser is used as a "scalpel", allowing a complete resection of laryngeal tumors in one block and a histological assessment of the margins. In the treatment of carcinoma in situ and severe dysplasia, we perform a laser-decortication of one or both vocal cords, leaving the vocal muscle intact (endolaryngeal laser-resection type I). Limited carcinomas of one vocal cord undergo a cordectomy, leaving the anterior commissure behind (endolaryngeal laser-resection type II). Extended and bilateral vocal cord carcinomas are treated by an extended cordectomy, which can comprise resection of one of the arytenoid cartilages if necessary (endolaryngeal laser-resection type III). Vocal cord carcinoma with extension to one or both false cords (stage T2) require a complete resection of one or both vocal and false cords in combination with an arytaenoidectomy, if necessary. The resection comprises the inner perichondrium of the thyroid and cricoid cartilages as well as the cricothyroid membrane (endolaryngeal laser-resection type IV, endolaryngeal exenteration).