Oncological outcome after CO2 laser cordectomy for early-stage glottic carcinoma

This study aims to define indications for micro-endoscopic laser surgery in early glottic carcinoma (Tis, T1a and T1b), to examine patterns of local recurrences and related re-treatment methods. A cohort of 79 patients with previously untreated early glottic carcinoma, subjected to endoscopic CO2 laser excision between January 1993 and October 2000, was retrospectively examined. Patients included in data analysis had a mean follow-up of 39 months. Depth and extension of excisions were graded according to European Laryngological Society Classification, and included 5 types of cordectomy. Actuarial overall survival, determinate survival, disease-free survival, ultimate local control, and laryngeal preservation rates, at 3 years, were 97.5%, 98.7%, 89.9%, 92.4%, and 97.4%, respectively. Survival curves for overall and disease-free survival were calculated from the date of diagnosis using the Kaplan-Meier method. Of the 8 patients with local recurrences, 5 were managed with larynx-sparing treatment: a second endoscopic CO2 laser cordectomy was performed in 2 patients, a supracricoid laryngectomy in 2 patients, and one patient was treated with radiotherapy. The remaining 3 patients were submitted to total laryngectomy, one of whom died due to neck metastases. One patient died from other causes. All other patients were alive and disease-free at the last follow-up. Understanding the diffusion pathways and timing of laryngeal glottic cancer is important both for treatment and prognosis. Correct knowledge of the subsites of the larynx and the routine use of pre-operative and intra-operative diagnostic assessment is useful in the selection of the appropriate type of resection. Micro-endoscopic laser surgery is efficacious for early glottic carcinoma, with oncological results comparable to those observed following radiotherapy or conventional partial laryngectomy, however, in this case, local recurrences have a greater range of re-treatment options.