Laser Microsurgery for Tongue Cancer Reduces Tissue Damage

Transoral laser surgery to remove cancer at the base of the tongue is as effective as more invasive open surgery, and may improve quality of life, according to a new study.

Researchers at Rush University Medical Center (RUSH; Chicago, IL, USA) conducted a retrospective chart review of 71 patients with biopsy-proven base of tongue squamous cell carcinoma; of these, 1 (1.4%), 9 (12.7%), 7 (9.9%), and 54 (76.1%) patients were stage I, II, III, and IV, respectively, at diagnosis. The patients then underwent transoral laser-excision microsurgery and were followed for at least 24 months. Disease-specific and overall survival data were determined, and quality-of-life (QOL) data were obtained using the University of Washington QOL instrument.

The researchers found that at 24 months overall survival was 90% and disease specific survival was 94%. QOL data obtained for 46 patients revealed that 91% of the patients responding experienced mild or no pain at all. In addition, 97% had minimal impairment or normal swallowing function. None of the patients interviewed were using a gastrostomy tube after 18 months, with an average gastrostomy use of just over three months overall; 69.6% of the patients reported normal speech. The researchers added that no significance was detectable between survival and gender, overall stage, tumor size, nodal status, or adjuvant therapy. The study was published in the July 2009 issue of the journal Otolaryngology Head and Neck Surgery.

"Due to the precision of this surgery, most patients require less adjuvant chemotherapy and in some cases patients will not need chemotherapy,” said lead author Professor Guy Petruzzelli, M.D., Ph.D., chief of the section of head, neck, and skull base surgery at RUSH. "And the functional outcomes are superior. Patients are able to speak and swallow much sooner and better than with an open technique.”

Transoral laser microsurgery is performed through the mouth using an endoscope with a camera and microscopic lens to view the area. Using a carbon dioxide (CO2) laser and microstaging, the surgeons carefully remove the tumor in small pieces, minimizing disruption to nearby tissues, thus reducing complications and the likelihood of infections. Using this approach avoids injury to delicate structures in the neck, such as the voice box, the trachea, the esophagus, lymph nodes, muscles, and large nerves, which have previously made surgical resection difficult without causing significant complications to the patient, including speech and swallowing impairment.

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