anyone have this done?

This message has been edited. Last edited by: Dr Vinod K Joshi,

no if you have it done let me know how it went and did it work

from Laser Microsurgery for Throat Cancer (Mayo Clinic)

quote:

Transoral laser microsurgery uses special instruments called endoscopes to view the larynx and pharynx. The surgeon directs the CO2 laser with the help of a micromanipulator fixed to a surgical microscope. Looking through the microscope, the surgeon follows the tumor and divides it into manageable pieces that can be removed through the endoscope. Selected "margins," or tissue edges, are carefully marked and checked during the operation by a "frozen-section" pathologist who cuts, stains and examines the margins for microscopic tumor not detectable by the surgeon. It is a customized, step-by-step process. Several weeks later, a "second-look" procedure is often done to remove any excessive healing tissue and to check for any impending recurrence of cancer, which can be removed with the laser at that time.

Transoral laser microsurgery has many advantages over conventional, open-neck surgery. Among them are:

• More normal tissue is saved.
  
• Normal tissue does not have to be disturbed to reach the cancer, as is the case with the standard, open-neck surgery.
  
• Patients usually spend only a day in the hospital, versus five days or more with conventional surgery. (Time in the operating room may be longer with laser surgery compared to the standard operation.)
  
• Patients recover swallowing and speech functions more rapidly and predictably.
  
• Few patients require a tracheostomy, an artificial opening in the neck for breathing.
  
• Conventional surgery and radiation treatments are still options at a later time.
  
• Microsurgery can be converted to the standard, open-neck procedure during the operation if necessary.

Dividing a tumor into smaller pieces to remove it flies against a conventional surgical principle that says a tumor must be taken out whole to prevent cancer cells from escaping. But extensive experience over 20 years has shown otherwise.

Head and neck tumors never grow as a perfect sphere. They follow the surrounding anatomy. Some invade muscle but not cartilage; others follow spaces around nerves. Each tumor is unique, especially in its character of invasion. Using a microscope allows the physician to view how the tumor interacts with the surrounding anatomy and to be meticulously precise in its removal. It also provides reliable information about the stage of the tumor.

Laser microsurgery may also tell the physician when radiation treatments are not needed. Some bulky tumors turn out to be superficial, and some small tumors have extensive, iceberg-like extensions. If the surgeon can determine a superficial tumor has been removed and there is little chance of it spreading to the neck, radiotherapy can be avoided.

Patients are carefully evaluated on a case-by-case basis to determine whether transoral laser microsurgery could be helpful to them.

Hope that helps.

wife has been googling her heart out. she is so worried about me having my voice box removed, since once it is gone, it is gone for good. following is an article she pulled up:

ransoral Laser Microsurgery



Removing throat and neck tumors through the mouth minimizes risks and speeds recovery.


Listen to Bruce Haughey, MD, describe this procedure in a Cancer Connection podcast.


By Gwen Ericson
Article originally appeared in the spring 2008 issue of Outlook magazine

A diagnosis of cancer of the mouth or throat can be especially devastating. Chemotherapy, radiotherapy and surgery to treat the condition can dramatically alter facial appearance and threaten the ability to swallow, talk, eat, smell, taste, hear and even to breathe normally.


Bruce Haughey, MD, and his colleagues who treat head and neck cancer at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine have been able to significantly lessen the impact of an oral or throat cancer diagnosis.


Working through an operating microscope as he performs the surgery, Haughey gets a close-up view of the tumor site, allowing pinpoint accuracy while removing the diseased tissue.
Whenever possible, they are using new surgical techniques that don't require cutting through the skin and muscle of the neck. In many instances, these minimally invasive, transoral (through-the-mouth) surgeries are getting patients out of the hospital faster, controlling the cancer better, and preserving mouth and throat function more effectively.
Haughey, the Dr. Joseph B. Kimbrough Chair in Maxillofacial Surgery and Prosthodontics and chief of the Division of Head and Neck Surgical Oncology, tells of a patient who recently contacted him because her doctor had offered her lengthy and expensive chemotherapy and radiation treatment for vocal-cord cancer.

"She had heard about the minimally invasive surgery we were performing for laryngeal cancer," Haughey says. "It wasn't something that was available at any of her local Washington, D.C.-area hospitals. She wanted to get rid of her cancer but was hoping to avoid the long treatment and recovery and high expense of chemotherapy and radiation."

Using transoral laser microsurgery – in which a microscope and laser are used to view and cut out the cancer without opening the neck – Haughey was able to get the patient out of the hospital in one day. And that was the extent of the treatment she needed because the surgery removed all detectable traces of the cancer. The patient was "tickled pink," Haughey says.

The neck is packed with delicate and crucial structures – the voice box or larynx, the windpipe or trachea, the esophagus, the tongue, muscles that move the jaws and allow the head to turn, large nerves, lymph nodes and lymph vessels, blood vessels, the spine and many more. Not only does reaching a throat tumor by opening the neck threaten these structures – potentially affecting speaking, eating, drinking, smelling, tasting and breathing – but it also creates a wound that even when healed can interfere with mobility and function. If it doesn't heal well, the incision can be a conduit for leakage of saliva and other fluids.

So when a patient's circumstances permit, Haughey and colleagues Brian Nussenbaum, MD, and Ravindra Uppaluri, MD, PhD, remove throat and mouth tumors transorally, using instruments specifically designed for insertion through the open mouth. For cancer of the larynx, for example, the surgeon first inserts a tube into the throat and expands it so that he can slide in an endoscope with a lighted camera and microscope lens to illuminate and view the area, a laser for cutting and other instruments to grasp tissue or hold it out of the way.

Using an endoscope or operating microscope "leads to a high level of precision in removing the whole tumor," says Haughey, "and contributes to the very good cancer outcomes we see with the procedure."

In a typical open surgical procedure to remove a throat tumor, a larger block of tissue would be cut away around a tumor. But in transoral laser microsurgery, a lot of the guesswork is eliminated as the tumor is cut out piece by piece with the laser until all traces are gone. Nearby tissue is disrupted to a lesser degree. The microscope increases the certainty that the doctors have eliminated all cancerous tissue.

Haughey and colleagues have just completed a study of patients with larynx, oral cavity and pharynx tumors treated with these endoscopic resection techniques and radiotherapy when necessary. After two years, none of the patients in the study have had a primary tumor recurrence. "We're delighted with that result," Haughey says. "Two years is the interval in which treatment failure usually occurs, if it is going to."

In addition to faster and easier recovery and better control of cancer, these techniques offer better preservation of speech and swallowing because of their conservation approach. Another reason transoral surgery leads to better functionality is that it often doesn't require a tracheostomy in which an opening is cut in the windpipe and a tube inserted for breathing. In open surgical neck procedures, about 80 percent of patients need a tracheostomy; with minimally invasive techniques that percentage is in the teens. Tracheostomy markedly affects breathing, speech and swallowing, temporary but sometimes permanent changes.

To enable effective transoral surgeries, physicians had to design instruments of the right diameter, length and configuration. Haughey is working with a German company that created many of the original instruments to develop one that will allow viewing and performing laser surgery around a corner, enabling removal of more types of cancer.

For some types of head and neck cancers, nonsurgical combination treatments consisting of chemotherapy and radiation therapy are the treatment of choice and may be used more frequently at other cancer centers for a variety of head and neck cancers. Unfortunately, in some patients, this approach can lead to greater tissue damage than even open surgery and can obliterate swallowing and speech function permanently or require major reconstructive surgery.

"With the ongoing improvements in the surgical technology for transoral laser microsurgery and the compelling data suggesting this is an effective cancer-curing procedure, we are probably justified in offering it to virtually any patient who is suitable for the technique," Haughey says.

Because of the advantages of transoral surgery, the team held a course at the School of Medicine in May to teach these exacting techniques to experienced professionals from around the world. This was the first formal course in the United States on this type of surgical approach to head and neck cancer.

Haughey has led the development of methods for reconstructing tissues damaged by cancer – including pioneering techniques for reconstructing the tongue using a flap of skin and muscle from the forearm. But with minimally invasive techniques, the need for reconstruction is minimized. "We're left with a relatively small wound that heals fairly quickly without additional tissue being required for reconstruction."

Transoral surgical techniques for head and neck cancer have answered an important need.

"We are dealing with some of the most visible parts of the body as well as some of the most used functions," Haughey says. "We have worked to develop these procedures because we take both the treatment of the tumor and the functional outcome very seriously."

http://www.siteman.wustl.edu/internal.aspx?id=2836

Pete,

This is absolutely fascinating. I sent the article to a good friend who is a medical laser engineer asking if he knows more, can give some risk factors, stats, etc., that weren't discussed in the article.

He always asks who the equipment manufacturer is - I guess that like auto makers, some are superior to others. If this works out for you, make sure you get that information so that I can run it by him.

I hope that you're eligible for this and that it is still a viable option.

Best of luck to you,

Mimi

Kind of interesting telephone call from my karate instructor this afternoon. He was all excited about another one of his students who has a small business told him about one of his customers was leaving for Seoul Korea to pick up his wife. She had throat cancer and the hospital was wanting to take her voice box out before she opted to travel to Seoul, Korea. She is Korean and traveled to a university cancer center in Seoul Korea and they said, no not necessary and did some surgery. I don't have the details. Just so happens she was going to the same hospital that also wants to yank my voice box out. I googled the Korean connection but couldn't hone in on it. However, I am headed to a cancer center the end of this week or the beginning of next week and hope I can get some good news.

The thing one must remember when looking at opinions or options is that if ones makes a bad choice it can be curtains. I wonder if the doc's don't just say take out the voice box to make sure they get all the cancer and not have to worry about 2nd guessing?

This message has been edited. Last edited by: pete228,

Oncologic outcomes of transoral laser surgery of supraglottic carcinoma compared with a transcervical approach.

quote:

Oncologic outcomes of transoral laser surgery of supraglottic carcinoma compared with a transcervical approach.
Cabanillas R, Rodrigo JP, Llorente JL, Suárez C.
Departament of Otorhinolaryngology, Hospital Universitario Central de Asturias, and Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Oviedo, Spain. rcabanillas@telecable.es

BACKGROUND: To evaluate the oncologic effectiveness of transoral laser surgery of supraglottic cancer, we compared a group of patients treated with laser surgery, with a stage-matched group treated with a transcervical approach.

METHODS: Twenty-six patients who underwent laser surgery were retrospectively compared with 26 patients who underwent a transcervical approach. In both groups, the patients were classified as follows: 8% stage I, 23% stage II, 46% stage III, and 23% stage IV.

RESULTS: The 5-year disease-specific survival rates were 80% for the laser group and 72% for the transcervical group (p = .5). The ultimate 5-year laryngeal preservation rate was 86% in the laser group and 80% in the transcervical group (p = .6). In both arms, all patients classified as T1 and T2 who survived 5 years after the surgical treatment of tumors retained the larynx.

CONCLUSIONS: The oncologic results of transoral laser surgery of supraglottic cancer are equivalent to those of the classic transcervical approach.

well i have my appointment next week at a cancer center and only thing i know right now is that they will be conducting a lot of tests.

i am sure i will be learning a lot about the process and procedures and am hoping my case is an appropriate for use of these methods. either way, i will surely have something of interest to post. the more info we can spread around the better off as a whole, we will be. sounds kind of korny, doesn't it? ROFL

from Laser Microsurgery for Tongue Cancer as Effective as Open Surgery

quote:

Laser surgery to remove cancer at the base of the tongue is as effective as more invasive open surgery

Transoral (through-the-mouth) laser surgery to remove cancer at the base of the tongue is as effective as more invasive open surgery and may improve quality of life according to a new study by Rush University Medical Center. The study is published in the July issue of the scientific journal Otolaryngology -Head and Neck Surgery.

The study involved a retrospective chart review of 71 patients who underwent transoral laser microsurgery for squamous cell carcinoma of the base of the tongue. At 24 months, overall survival was 90 percent and disease specific survival was 94 percent. Quality-of-life data, obtained for 46 patients, revealed the majority had mild or no pain, minimally impaired to normal swallowing, and normal speech.

Historically, the tongue base could only be safely accessed through complicated open surgical approaches through the neck. Delicate structures in the neck, such as the voice box, the trachea, the esophagus, lymph nodes, muscles and large nerves make surgical resection difficult with significant complications including speech and swallowing impairment.

Advances in transoral laser microsurgery have transformed the surgeon's ability to treat cancer that was not otherwise amenable to surgical therapy. The surgery is performed through the opening of the mouth using an endoscope with a lighted camera and microscopic lens to view the area. Using a CO-2 laser and micro-staging, surgeons carefully remove the tumour in small pieces minimizing disruption to nearby tissues, thereby reducing complications and the likelihood of infections.

With magnification of normal and abnormal tissue the surgery is very precise which contributes to very good cancer outcomes.

Dr. Guy Petruzzelli, study author and chief of the Section of Head, Neck and Skull Base Surgery and Professor of Cancer Research at Rush University Medical Centre said:

'Due to the precision of this surgery, most patients require less adjuvant chemotherapy and in some cases patients will not need chemotherapy. And the functional outcomes are superior. Patients are able to speak and swallow much sooner and better than with an open technique.'

In the study, 91 percent of patients responding experienced mild or no pain. Also, 97 percent had minimal impairment or normal swallowing function. In fact, no patients interviewed were using a gastrostomy tube after 18 months, with average gastrostomy use of just over three months overall. Finally, 69.6 percent of patients reported normal speech.

'Transoral laser surgery is an acceptable and in many cases preferred option for managing appropriately sized tumors of the back of the tongue. Its overall safety and functional outcomes are in many cases superior to traditional open surgeries and potentially high dose chemotherapy and radiation,' said Petruzzelli.

What fantastic news. Really encouraging to read about the progression in treatment for Head & Neck cancer.