TREATMENT OF HYPOPHARYNGEAL CARCINOMA .5. LONG-TERM RESULTS OF TRANSORAL LASER MICROSURGERY - DISCUSSION

The results of transoral laser microsurgery of hypopharyngeal carcinomas have been described in previous publications. These arc discussed on the basis of literature reports on the therapy used, inclusive of surgery and/or radiotherapy and/or chemotherapy. The most important parameters of prognosis include neck and distant metastases as well as multiple tumors. In analysing results of laser therapy, prognosis has been better compared to conventional types of therapy regarding loco-regional control and survival rates. Surgical overtreatment in the sense of pseudo-radicality, especially when sacrificing parts of the larynx not involved by tumor, is compared to precision surgery employing the operative microscope and the laser. The latter, presupposing the necessary experience and complying with certain precautions, offers high oncological safety in resection of the primary tumor while at the same time preserving functionally important organic structures. The difficulties arising from a comparative assessment of therapeutic results are dealt with in detail. In terms of radiobiology, radiotherapy is generally given early (after about 2 weeks) in regions well supplied with blood and has been found to be very effective. Local immunologic factors concluding minimally-invasive surgery in the.neck) can also be responsible for a favorable clinical course of disease, as can psycho-oncological aspects (quick functional rehabilitation as well as reintegration into job and family). The generally accepted, but probably outdated, guidelines for conventional head and neck surgery demanding extremely radical surgery of primary tumors, bloc resections, etc. must be critically revised. The prejudices against minimally-invasive therapy concepts with function-preserving surgery of the primary tumor and neck, and adjuvant therapy solely depending on post-therapeutic staging have to be overcome. Apart from loco-regional control and survival rates, preservation of the quality of life as a critical of success is gaining increasing importance in therapeutic considerations.