Functional and oncological outcomes of transoral laser versus robotic surgery in supraglottic squamous cell carcinoma

Objective: To compare the surgical, functional and oncological outcomes of Transoral Laser Microsurgery (TLM) and Transoral Robotic Surgery (TORS) for the treatment of supraglottic squamous cell carcinoma. Study Design:<br /> Retrospective case series with prospective data. Settings:<br /> Tertiary Academic Medical Center. Methods:A chart-review analysis, with prospective follow-up was performed on 122 patients treated for a supraglottic squamous cell carcinoma with either TLM or TORS between 2003 and 2019. Patients were grouped according to the surgical technique used. Clinical, surgical, functional and oncological outcomes were compared, including local and regional controls, DFS, and OS, and postoperative complications. Results: A total of 122 patients, including 47 treated with TLM and 75 with TORS. Negative margins were observed in n = 12/47 (25.5 %) of TLM cases and n = 4/75 (5.3 %) of TORS cases (p < 0.05). There was no significant difference between the two techniques in terms of 5-year local and regional control, however a significant difference was found in disease-free survival and overall survival. The functional laryngeal preservation rate was 97.8 % in the TLM group and 100 % in the TORS group. Conclusion: Both techniques appear to be safe and effective, though TORS shows superiority in achieving negative margins compared to TLM. Therefore, the choice of technique should be tailored to available resources, surgical team preferences, and experience, while also considering the learning curves associated with each approach.