Published online May 28, 2016. doi: 10.5319/wjo.v6.i2.41
Peer-review started: December 1, 2015
First decision: January 15, 2016
Revised: January 16, 2016
Accepted: March 9, 2016
Article in press: March 14, 2016
Published online: May 28, 2016
AIM: To evaluate the efficacy of Holmium:Yag laser resection for oropharyngeal squamous cell cancer.
METHODS: A prospectively collected case series of all patients with oropharyngeal squamous cell carcinoma undergoing laser resection using the Holmium:Yag laser technique only over a 15 year period at a tertiary referral centre. All patients underwent long term follow up with regular clinical and radiological surveillance, when indicated. All patients were operated on under general anaesthetic with a laser-safe endotracheal tube. Typically laser resection was performed first using an operating microscope, followed by neck dissection. The tumour was held with a Luc’s forceps or Allis clamp. The Holmium:Yag laser was implemented via a fibre delivery system. The Holmium:Yag laser fibre, of 550 micron diameter, was inserted through a Zoellner sucker and attached via steri-strips to a second Zoellner suction to provide smoke evacuation. The settings were 1J/pulse, 15 Hz, 15 W in a continuous delivery modality via a foot pedal control. The procedure is simple, bloodless, effective and quick. All surgeries were performed as day cases.
RESULTS: Twenty-seven oropharyngeal squamous cell cancer patients were identified, at the following subsites: 23 lateral pharyngeal wall/tonsil, 2 anterior faucal and 2 tongue base. Of the 23 tonsil tumours, 19 required no further treatment (83% therefore had negative histopathological margins) and 4 required chemoradiotherapy (17% were incompletely excised or had aggressive histopathological features such as discohesive, perineural spread, vascular invasion). The 2 patients with anterior faucal pillar neoplasia needed no further treatment. Both tongue base cancer cases required further treatment in the form of chemoradiotherapy (due to positive histopathological margins). Postoperatively, patients complained of pain locally, which resolved with regular analgesia. There were no postoperative haemorrhages. Swallowing and speech were normal after healing (10-14 d). There was one case of fistula when neck dissection was carried out simultaneously; this resolved with conservative management. All patients were followed up with serial imaging and clinical examination for a minimum of five years. Median follow up was 84 mo.
CONCLUSION: Holmium:Yag lasers are a safe and effective treatment for Stage 1 and 2 squamous cell carcinoma of the oropharynx, excluding the tongue base.
Core tip: Oropharyngeal squamous cell carcinoma is increasing in incidence. Management is controversial due to the large human papillomavirus cohort. The gold standard remains single modality therapy for early stage disease, either primary surgery or radiotherapy. Laser resection is one of the viable surgical options. We present a series of patients treated with Holmium:Yag laser resection. Holmium:Yag lasers are a safe and effective treatment for Stage 1 and 2 squamous cell carcinoma of the oropharynx, excluding the tongue base. Its uses could be extended within the speciality and elsewhere, particularly with a robotic arm.