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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 2000 December;50(4):193-6
CO2 laser in the treatment of T1a and T1b glottic cancers
Stomeo F., Meloni F., Bozzo C., Cesarani A.
Università degli Studi - Sassari Dipartimento Struttura Specialità Microchirurgiche Sezione di Otorinolaringoiatria
Background. Laser surgery has deeply influenced and divided laryngologists, since the most “enthusiasts” among them might have excessively extended its application in cases of laryngeal malignancies, whereas the most critics could have been too reluctant. The authors state to belong to those who deem laser surgery as a very useful therapeutical tool, which gives the best results only when applied after a thorough selection of cases; particularly in case of glottic tumours T1a and T1b with glottic onset and subsequent commissural involvement, the use of CO2 laser permits to obtain the best results, either from a curative or functional point of view, appearing as the current surgical technique of choice for the above mentioned neoplasm.
Methods. During the period 1990-1993, 50 patients (age: 34-83) have been treated by means of CO2 laser, 35 (70%) being classified as T1aN0, 15 (30%) T1bN0; clinical staging was achieved through videolaryngoscopy and videolaryngostroboscopy. On the basis of clinical staging, patients underwent different kind of treatment, which varied from a subligamentous cordectomy (type 2 of Remacle) applied to some T1a, to an extended cordectomy (type 5 of Remacle) for all 15 T1b patients. All patients have been followed-up for at least 5 years, monthly during the first year, bimonthly in the second year, every three, four and five months, respectively three, four and five years after surgery. Postsurgical complications, uncorrect anatomical outcomes and overall survival have been evaluated.
Results. We observed three (6%) granulomas in pT1a cases and five (10%) commissural synechiae in pT1b cases. We never observed subcutaneous enphysema, postoperative bleeding, laryngeal motility impairment, nor tracheostomy was needed in any case. The average period of hospitalization was 2.34 days.
Conclusions. Data obtained from our series confirm that in cases of glottic malignancies staged T1a and T1b the treatment of choice is represented by the excision of the neoplasm by means of CO2 laser under microlaryngoscopy.