gms | German Medical Science

Aim: The authors’ aim was to evaluate the oncological results of endoscopic laser surgery for T1 glottic carcinoma in a large, unselected group of 214 consecutive patients from a university-based referral center that uses transoral laser surgery as the standard approach to these tumors. Familiarisation with the practicability of endoscopic-microscopic laser surgery in relation to the stages of vocal cord lesions, the other aim was to work up and confirm subgroups of laser cordectomies such as “superficial”, “partial”, “total” and “extended” ones.

Methods: This study is based on a retrospective clinical-pathological analysis of "en bloc" resected glottic specimens and patient's charts obtained from 214 patients having T1 vocal cord carcinoma. All of them were treated between May 1987- March 2004 by endolaryngeal laser microsurgery and they have more than 2-year follow-up. After histological examination, the tumors were classified as 181 pT1a and 33 pT1b. Main oncological outcome measures were local control with initial laser therapy, ultimate local control after laser-, or conventional salvage treatment, organ preservation, overall and cause specific survival.

Results: Endoscopic CO2-laser surgery alone controlled the early vocal cord carcinoma in 184 patients, so the local control with initial laser treatment was 86%. The remaining 30 patients required salvage therapy, such as repeated laser excision, partial and total laryngectomy or radiotherapy. After the”laser-salvage” treatment the local tumor control rate with exclusive laser surgery was mounted to 93.4% and with the conventional salvage therapy finally resulted 97.9 %. The organ preservation’s rate achieved 96.3 % and 8 patients had lost their larynges. The 5-year cause specific survival calculated by Kaplan-Meier method was 97.7 %. The vocal function was really good in most patients after laser surgery because no excess of normal tissue was sacrificed.

Conclusions: Based on these favorable oncological results and other advantages of the laser surgery, such as time- and cost-effectiveness, low morbidity, fair local control rate (93.4%) with sole laser surgery and excellent re-treatment options in case of local failure, – as the change of therapeutic paradigm – endoscopic minimally invasive laser cordectomy should be the first choice of treatment for T1 glottic cancer. Radiotherapy and open partial laryngectomy should be reserved for salvage therapy.