Transoral LASER microlaryngosurgery is already established as an effective modality
for treatment of early glottic cancer. The vocal cords are poor with lymph pathways
so regional metastases occur comparatively lately. It gives good functional results
as phonation, respiration and swallowing are preserved.
The aim of this paper is to share our experience and outline the surgical problems
and prognostic factors for successful tumor control.
Materials and methods:
We conducted a retrospective study on 82 patients with early laryngeal carcinoma stage
Tis or T1 who underwent laser cordectomy at Ministry of Interior Medical Institute,
Sofia for a period of 7 years. All the patients were followed up monthly for the first
3 postoperative months and at least twice per year thereafter.
Results:
After the operation 58 of the patients with Tis and T1a (95.02%) were with histologically
clean specimen margins. In 3 patients second look LASER microsurgery was performed
without histological evidence for residual tumor. In 8 cases with T1b (38.1%) the
resection borders showed tumor infiltration, which demanded a broader LASER excision.
Residual tumor was found in 5 cases, who underwent postoperative radiotherapy. The
larynx was spared in 79 patients (96.34%). All 3 patients who underwent salvage laryngectomy
were from the group with anterior commissure involvement.
Conclusion:
Laser surgery of early laryngeal cancer is a method of radical treatment with excellent
functional results. Patients with anterior commissure involvement are more difficult
to operate and the risk for prelaryngeal tumor spread increases. Of utmost importance
for the success of the operation is the careful selection of surgical candidates and
close collaboration with the pathologist.
