Practical considerations for choosing transoral laser microsurgery versus transoral robotic surgery for supraglottic laryngeal cancers

Abstract

PURPOSE OF REVIEW: To review the pros and cons of treating supraglottic laryngeal cancer with transoral laser microsurgery (TOLM) or transoral robotic surgery (TORS). RECENT FINDINGS: The use of TORS is limited by the cost and the availability of the robots despite a faster learning curve than TOLM. The laryngeal exposure difficulty, the use of long instruments, and the restricted view of the surgical field consist of the primary limitations of TOLM, which are addressed in TORS technology through a 30° view of surgical fields, and the 180° amplitude of the instruments. The indications of TOLM and TORS are similar and include cT1-T2 and some selected cT3 with moderate invasion of the preepiglottic space. The rates of positive margins in TORS-SGL are lower than those of TOLM-supraglottic laryngectomy (SGL), while both approaches report similar duration of hospital stays. Patients treated with TORS report higher rates of percutaneous gastrostomy and temporary tracheotomy compared to TOLM. The feeding tube and oral diet re-start appear comparable between both groups. The overall survival, disease-free survival, local, regional, and relapse-free survival rates of TORS are reported to be higher than those found for TOLM SGL. SUMMARY: TORS and TOLM SGL are well tolerated and effective approaches for cT1, cT2, and some selected cT3 LSCC. The functional and surgical outcomes appear comparable. TORS could have superior survival and loco-regional outcomes than TOLM, which could be attributed to the fastest TORS learning curve, and its superiority in terms of tumor/operating field visualization, and instrument movements.