Transoral endoscopic CO2 laser microsurgery for early laryngeal cancers.
BACKGROUND
The impact of transoral endoscopic CO(2) laser microsurgery (TLM) for the treatment of Tis, T1, and T2 glottic cancer on local disease control, survival, and laryngeal preservation was investigated.


METHODS
From October 1999 to February 2008, 48 patients with a previously untreated early laryngeal malignant tumor who had been treated with TLM were enrolled in this study. Overall survival, primary and ultimate local control, and larynx preservation rates were calculated by the Kaplan-Meier method. The impact of anterior commissure involvement on the local control rate after primary TLM was performed was analyzed by the log-rank test. Functional results for postoperative voice were analyzed by patient telephone intelligibility.


RESULTS
The overall 5-year survival rate was 97% (95% CI, 94%-100%), the primary 5-year local control rate was 72% (95% CI, 66%-92%), the local control rate exclusively for TLM was 85% (95% CI, 79%-99%), and the ultimate 5-year local control rate was 100%. Larynx preservation rate was 97% (95% CI, 94%-100%). Anterior commissure involvement in glottic cancer showed no statistically significant difference in primary local control rate (p = 0.9). Regarding the post-operative voice function, 47 patients (97.9%) were able to maintain adequate telephone intelligibility.


CONCLUSIONS
In terms of long-term survival and locoregional control, TLM is an optimal primary treatment modality for early laryngeal cancer. With TLM treatment, involvement of the anterior commissure is not a poor prognostic indicator.
Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taipei, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Li-Jen
LJ
Hsin
Tuan-Jen
TJ
Fang
Kai-Ping
KP
Chang
Ku-Hao
KH
Fang
Ngan-Ming
NM
Tsang
Yao-Liang
YL
Chen
Shih-Ming
SM
Jung
Albert Re-Ming
AR
Yeh
Sheng-Po
SP
Hao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000601:surgery*; D007828:Laryngoscopy; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D015996:Survival Rate