Laser carbon dioxide cordectomy versus open surgery in the treatment of glottic carcinoma: Our results

Abstract

OBJECTIVE : To analyze oncologic results in patients with glottic cancers treated respectively, by laser CO₂ or open surgery, taking into account specific-disease survival, rate of locoregional recurrences, and their salvageability.

STUDY DESIGN : Retrospective study of 198 patients treated from January 1993 to June 2002 in the department of otorhinolaryngology at a Catholic university in Rome.

METHODS : Glottic carcinoma were treated by laser CO₂ cordectomy in 132 patients (group 1) and by open surgery in 66 patients (group 2). The statistical analysis was performed by Kaplan Meyer method, log rank test, and x 2 , test.

RESULTS : The log-rank test points out significant differences between the 2 groups regarding specific-disease survival; no differences were found for disease-free survival. Within group 1, 16 patients developed local failure, which was retreated in 6 cases with laser surgery; in 9 (6.8%) with total laryngectomy, only 1 case was inoperable. In this group, 10 patients (62.5%) were salvaged. Within group 2, 18 patients developed local recurrences, which was retreated in 14 (21.21%) cases with total laryngectomy; the other 4 cases were not suitable for surgery. Of these 18, 8 patients (44.5%) were salvaged.

CONCLUSIONS AND SIGNIFICANCE : Our results show significant differences between the 2 groups concerning the specific-disease survival and the salvageability of local recurrences. In fact, in group 1 we found a higher salvage rate and a lower incidence of total laryngectomy. As already suggested, laser therapy leaves the laryngeal cartilaginous framework intact, avoiding the spread of the tumor out of laryngeal organ and resulting in a more favorable oncologic outcome.