gms | German Medical Science

The objective of this paper is to report our experience(s) on the reliability of endolaryngeal CO₂ lasermicrosurgery and its results as single treatment for glottic carcinomas.

In a period of 23 years (1987–2010) a total of 375 laser-cordectomy or extended laser-excision (ELS-type V-VI) were performed on 324 patients. Of them 289 patients with 21 Tis, 179 T1a, 57 T1b and 32 T2-3 glottic cc. (treated:1987–2007) have more than 3-years, and 232 pat. (treated 1987–2004) have more than 5-years follow-up.

For „en-block” resection of tumor with „free margins, 4 subgroup of laser-cordectomies and in 11% „extended” cordectomy or laser-hemilaryngectomy were applied.

The laser-related 3-years tumor-free survival after the first singel resection revealed 87.5% (253/289 patients). These patients did not require additional surgery or adjuvant radiation therapy. Twelve incomplete resection and 24 local recurrences were detected and this 36 patients underwent additional treatment as followes: laser re-resections (14p.) – resulted in 4.9% plus survival rate (i.e. 92.4%), partial laryngectomy (5p.) radiotherapy (6p.) resulted in 2% – 2% plus in the end result:96.4% voice- and larynx preservation, and total laryngectomy became necessary on 11 patients (3.8%).

The CO₂ laser related 5-years survival rate was similar: 214/232=92.2%.

Conclusions: These analysis of our experiences and longterm results confirmed that laryngomicrosurgical CO₂-laser excision alone provide 92–93% 3-and 5-years survival rates and larynx-preservation. Now we stress, that endoscopic minimally invasive laser cordectomy should be the first choice of treatment for early glottic cancer.