CO 2 Laser Microsurgery for Tis,T1,and Selected Cases of T2 Glottic Carcinoma

Objectives: To define the oncologic efficacy of transoral endoscopic CO₂ laser surgery in early glottic carcinoma.

Methods: Retrospective study of 103 patients with well to undifferentiated glottic carcinoma (14 Tis, 68 pT1a, 14 pT1b, and 7 pT2 with impairment of vocal cord mobility) were treated from October 1993 to June 2001 at the Section of Otorhinolaryngology at the Department of Surgical Sciences and Organ Transplantations of Cagliari University, Italy. Mean follow-up was 3.9 years. Surgical treatment included endoscopic CO₂ laser cordectomies from type I to type Vc, according to the classification proposed by the European Laryngological Society in 2000.

Results: According to the Kaplan-Meier method, the probability of remaining free of local recurrence 3 years after primary surgery was 100% for the Tis group, 93.4% for the T1 group (SE 3.85%) and 100% for the T2 group. Local control at 3 years after exclusive CO₂ laser salvage surgery was 94.95% (SE 3.54%). The probability of remaining free of local recurrence 3 years after any type of salvage surgery was 100% for all the classes. Laryngeal preservation was achieved in 100% of the cases. Anterior commissure spread resulted in a not statistically significant difference in local control (P = 0.6), between the group of patients without (96.54%; SE 2.43%) and with anterior commissure involvement (87.5%; SE 11.69%).

Conclusions: According to our experience, endoscopic CO₂ laser surgery is an efficacious treatment for early stage glottic cancer.