Prof. Kirfi,

I wish you well on getting this started. It is a very important treatment modality that can obviate if not completely replace the need for radiation therapy for many laryngopharyngeal tumors. Particularly in the developing world radiation therapy may be hard to come by for many patients. Is there any chance you can get a laser with a "scanning" system? The Lumenis "AccuBlade" or the DEKA "SmartXide-2" are two great examples of this type of technology.

Let me know.

Warmly,

Paul Castellanos

No

I consider it to be an essential part of the armamentarium for the treatment of early laryngeal carcinoma.

Anterior commissure tumours probably do not have as good a functional result in terms of voice quality following laser resection compared with radiotherapy but otherwise it is an excellent modality of treatment with a short hospital stay and good functional and oncological results.

You need a good laser (Acublade is good) and the right trans-oral endoscopes.

Good luck

Regards

Sanjai Sood 

It is possible to perform transoral robotic surgery in supraglottic larynx and hypopharyngeal carcinoma. Studies have established several potential advantages of TORS over traditional treatment options such as avoidance of external incision and preservation of normal surrounding structures

Dear Prof Castellanos,

I am grateful for the comment and suggestions on the LASERs. I will get back to you whenever the need arises.

This mode oftreatment is extremely valuable in T1 and T2 and some selected T3 glottic and supraglottic lesions. However proper patient selection is mandatory. Extremely adequate exposure of the larynx and lesion are essential so as to be able to encompass the whole lesio of remove it safley. Intra-operative check biopsies are a plus in many cases . However I found this type of ultra conservative therapy inadeqaute in Nver-smoker patients as they have a worse progress of the disease compared to the classial smoker/dinker profile. Finally it is a very good alternative both effective nd cost effective for patients and localities where radiotherapy facilities and patient compliance are questionable.

Dear Mostafa,

Thank you for the information. We want to restrict ourselves to Tis, T1 and T2 Tumours. However, in most cases late presentation has been the norm. Your talk on patient selection is very vital and we've noted that.

To sum it up, thank you!

Dear Dr Kirfi,

We are also new in the LASER use for laryngeal cancers. We started off with posterior cordectomy for bilateral VC palsy, and some cases of airway stenosis. In our centre, radiotherapy still the preferred mode for earl laryngeal cancer cases. In some selected  patients, we do LASER but it is limited for early stages. Logistics problem may be in advantage if LASER offered. It is a one-off procedure as compared to daily radiation for weeks, if radiotherapy is used. However from our limited experience, in term of voice outcome, radiotherapy do better e as compared to LASER excision. In a nutshell, it is an individual-basis mode of therapy selection. All the best!

Irfan Mohamad

Malaysia

Dear Dr. Irfan,

Thank you so much for the information. We had some experience with the Diode laser in cordectomy for bilateral VC palsy too, and the results are encouraging; though we are yet to write about it. For the patient selection in the early laryngeal cancer, i quite agree with you because the outcome matters alot to both the patient, the surgeon and the system at large. My regards.

Dr. Kirfi, AM

Nigeria

Dear Dr. Kirfi

Transoral laser surgery has become the standard treatment of early glottic and supraglottic carcinoma. Exposure is not a problem in most of the patients, and hospitalization can be avoided, even for big resection. However the learning curve is long considering that only consolidated experience with early carcinomas will give you good oncological results with T3 carcinomas. 

Good luck and warm regards

Dear Dr. Mario,

Thank you for the answer. I believe with you that laser surgery has changed the perspectives of treatment modalities for laryngeal cancers, especially the early ones. And, i also believe on the lengthy learning curve especially among us from developing nations where the facilities are mostly not available. We want to start with Tis, T1 and T2 tumours Sir.

Warm regards

Dr Kirfi AM, Nigeria

As many have identified transoral laser is a valuable option for treatment of early glottic cancer. I would re-iterate the need for careful patient selection and also the issue of the learning curve. I would strongly recommend undertaking a formal training course with the first cases after being done with a precptor.

Dear Brian,

Good morning. Your answer noted. Patient selection is very important and also the issue of learning curve. I am grateful for the observations.

Accept the assurances of my best regards.

Happy Christmas in advance

the result of LASER therapy in laryngeal cancer is excellent  and comparable with other modalities like radiotherpy or  chordectomy It has the advantage of avoiding external incisions rapid ambulance overall less cost .. However if it is not available in developing countries -- radiofrequence  or chordectomy through laryngo-fissure is an alternative 

Dear Dr Mohamed,

Thank you so much. I read about the comparable outcomes in terms of oncological safety. I concur with you on the issue of avoiding external incisions, and patient ambulates faster than when a laryngectomy was performed. We are trying to popularise the procedure in developing sub-saharan Africa despite the challenges.

Thank you once again.

Dr. Kirfi, Nigeria