Advances in Transoral Approaches for Laryngeal Cancer

The field of transoral approaches to laryngeal cancer is in constant and rapid evolution. Starting from the eighties of the last century, when the first transoral laser laryngeal resections were described in the international literature, to the most recent publications about transoral robotic removal of the entire larynx, this topic has demonstrated to represent an interesting benchmark for the proof of principle of mini-invasive approaches to a dismal disease, once treated exclusively by disfiguring and mutilating open-neck approaches. This has been made possible thanks to a change of mind of the overall head and neck cancer surgical and non-surgical communities on one side, and by the recent implementation of a number of technologic tools such as new lasers, endoscopes, bioendoscopy techniques, robotic instrumentation, and ultrafrequency devices on the other.

The challenge ahead is to demonstrate that such conservative approaches may have the same oncologic outcomes than more aggressive therapeutic options, while allowing a superior quality of life, better functional outcomes, and more favorable cost-effectiveness ratio. A great workload is required to the modern head and neck surgical community to clearly define indications, treatment modalities, technical refinements, potential complications and pitfalls, contraindications, alternative therapeutic options and related results of the available transoral approaches to laryngeal cancer. This is nowadays particularly needed if one considers the rapidity of technological advances and their possible integration in the existent therapeutic algorithms.