Objective: Carcinomas of the piriform sinus have an unfavourable prognosis despite aggressive treatments. Most authors are therefore increasingly hesitant to offer patients treatment options including total laryngectomy. There is a tendency to treat piriform sinus carcinomas in a manner that preserves the larynx, whether by radiochemotherapy (sequential or concomitant), classic organ-preserving surgery, microendoscopic laser surgery, or a combination of these treatment options. The value of laser surgery in the treatment of more extensive carcinomas has not yet been precisely defined, unlike that of classic function-preserving surgery. An attempt has been made in this study to evaluate the possibilities and limits of microendoscopic laser surgery in the treatment of cT3 and cT4 carcinomas, based on a histological analysis of the patterns of spread. Methods: A total of 70 specimens obtained by pharyngolaryngectomy were subjected to a whole-organ section study. The carcinomas were also evaluated in respect of possible classic organ-preserving surgery on the basis of established selection criteria, and an attempt was made to define selection criteria for the use of microendoscopic laser surgery on the basis of the histopathological pattern of spread. Results: On the basis of the established selection criteria, such as fixation of the vocal fold, cricoid infiltration, spread of the tumour to the retrocricoid region and infiltration of the pre-epiglottic space, only very few T3 and T4 carcinomas of the piriform sinus can be treated with classic function-preserving surgery. Laser surgery is primarily determined by the pattern of spread and less by given anatomical landmarks. Selection criteria, such as have been established for classic function-preserving surgery, are not helpful for laser surgery. The main problem in microendoscopic laser surgery is the optimal exposure of the tumour. Conclusions: Assuming correct exposure of the tumour, function-preserving treatment by laser surgery can be carried out on more T3 and T4 carcinomas than would be possible with classic function-preserving surgery. The contraindication criteria for classic function-preserving surgery are not applicable to laser surgery because this form of surgery is determined by the tumour extension and not by anatomical landmarks.

Keywords:
Piriform sinus carcinoma, Microendoscopic laser surgery, Growth pattern
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© 2003 S. Karger AG, Basel
2003
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