Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Otorhinolaryngol. May 28, 2016; 6(2): 41-44
Published online May 28, 2016. doi: 10.5319/wjo.v6.i2.41
Use of Holmium:Yag laser in early stage oropharyngeal squamous cell cancer
Jagdeep S Virk, Mike Dilkes
Jagdeep S Virk, Mike Dilkes, Department of Head and Neck ENT, Barts and Royal London Hospitals, London E1 1BB, United Kingdom
Author contributions: Virk JS drafted the manuscript and performed literature searches; Dilkes M performed, collated and analysed all data.
Institutional review board statement: This study was registered with the clinical governance and ethics team. This study was approved and ratified by the ethics board.
Informed consent statement: All patients agreed to undergo this surgery after a multi-step consent process in keeping with GMC guidelines (United Kingdom).
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: There is no further data to share.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Jagdeep S Virk, MA, MRCS, DOHNS, E, Department of Head and Neck ENT, Barts and Royal London Hospitals, Whitechapel Road, Whitechapel, London E1 1BB, United Kingdom.
Fax: +44-203-8452964
Received: December 1, 2015
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.

Keywords: Holmium:Yag, Laser, Human papillomavirus, Oropharyngeal, Squamous cell carcinoma, Cancer, Squamous cell cancer

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.