This section describes efficacy outcomes from the published literature that the Committee considered as part of the evidence about this procedure. For more detailed information on the evidence, see the interventional procedure overview.
4.1 A retrospective comparative case series of 223 patients with T1 oropharyngeal carcinoma treated by transoral carbon dioxide laser surgery (TLS) with or without neck dissection (±ND) (n=53) or by electrocautery (n=170) reported that there was no significant difference in 5-year disease‑specific survival (89% for TLS±ND and 87% for electrocautery; p>0.05).
4.2 A prospective case series of 204 patients (of whom 203 were analysed) with stage III or IV oropharyngeal cancers treated by TLS±ND alone (53 patients) or by TLS±ND and combined adjuvant treatment (150 patients: 117 radiotherapy alone, 33 chemoradiotherapy) reported that rates of 5-year overall survival, disease-specific survival and disease-free survival were 78%, 84% and 74% respectively across all groups. TLS combined with postoperative adjuvant radiotherapy (in 117/204 patients) reduced the risk of death by over 50% (hazard ratio 0.33 to 0.48) compared against the risk of death in the group who received TLS±ND alone (53/204 patients).
4.3 The retrospective comparative case series of 223 patients reported a 5-year local control rate of 95% for TLS±ND and 91% for electrocautery (p>0.05; not significant).
4.4 The retrospective case series of 69 patients reported that 4% (3/69) of patients had disease recurrence at the primary site at a mean follow-up of 44 months. The 5-year local regional control rate in patients in whom adjuvant therapy was not indicated was 82%. The 5-year local regional control rate in patients who declined adjuvant therapy was 74%.
4.5 The specialist advisers listed key efficacy outcomes as local control, survival, margin control and local recurrence.