W Kehrl1, J Tolkemitt, P Düsterhus. 1. Universitäts-Hals-Nasen-Ohrenklinik, Klinik Marienkrankenhaus, Hamburg. Kehrl.HNO@marienkrankenhaus.org
Abstract
BACKGROUND: Transoral CO2 laser excision of early glottic cancer was first introduced in the 1970s. Since then it has become a serious alternative to surgery with conventional instruments. PATIENTS AND METHODS: Between January 1987 and December 1997, 46 patients with T2 N0 M0 glottic carcinoma have been treated by either transoral laser microsurgery or fronto-lateral partial laryngeal resection with curative intention. Long-term results of both methods were compared after analysation of tumor-localization and recurrence-rate. Evaluation parameters were: incidence of local recurrence and incidence of death due to local recurrence. Other aspects of investigation were hospitalisation-time and treatment related patient morbidity. RESULTS: Analysis of the data of our study shows that local recurrences were 5 % lower in cases of laser surgical tumor resection as opposed to conventional surgery (11 % vs. 16 %). If evaluated in accordance to localization of local recurrence in combination with primary tumor localization, results show that all three recurrent tumors in the group of laser resected patients had a primary in the anterior glottic area; two out of the three recurrences following fronto-lateral laryngeal resection were localized in the mid-third of the vocal cord. Hospital-admittance in laser-resected patients was shorter by one day when compared with the group of conventional surgery (10 vs. 11 days). CONCLUSION: T2-Tumors of the anterior glottic area should preferably be approached by conventional surgery (external approach), particularly when endoscopical visualization is difficult. In contrast, T2-tumors of the medial and posterior glottic area should be resected endolaryngeally with the laser.
BACKGROUND: Transoral CO2 laser excision of early glottic cancer was first introduced in the 1970s. Since then it has become a serious alternative to surgery with conventional instruments. PATIENTS AND METHODS: Between January 1987 and December 1997, 46 patients with T2 N0 M0 glottic carcinoma have been treated by either transoral laser microsurgery or fronto-lateral partial laryngeal resection with curative intention. Long-term results of both methods were compared after analysation of tumor-localization and recurrence-rate. Evaluation parameters were: incidence of local recurrence and incidence of death due to local recurrence. Other aspects of investigation were hospitalisation-time and treatment related patient morbidity. RESULTS: Analysis of the data of our study shows that local recurrences were 5 % lower in cases of laser surgical tumor resection as opposed to conventional surgery (11 % vs. 16 %). If evaluated in accordance to localization of local recurrence in combination with primary tumor localization, results show that all three recurrent tumors in the group of laser resected patients had a primary in the anterior glottic area; two out of the three recurrences following fronto-lateral laryngeal resection were localized in the mid-third of the vocal cord. Hospital-admittance in laser-resected patients was shorter by one day when compared with the group of conventional surgery (10 vs. 11 days). CONCLUSION:T2-Tumors of the anterior glottic area should preferably be approached by conventional surgery (external approach), particularly when endoscopical visualization is difficult. In contrast, T2-tumors of the medial and posterior glottic area should be resected endolaryngeally with the laser.