A retrospective study is reported on endoscopic CO2-1aser microsurgery in 69 patients with histologically verified early vocal cord cancer. A flexible nasopharyngolaryngoscope (STORZ Co) was used for preoperative assessment and occasionally for postoperative follow-up.Six years of experience with this technique have led to endoscopic cordectomy, previously not accepted as a therapeutic method alone, but which has become the favored method with use of the CO2 laser endoscopically. Laser surgery as a therapeutic endoscopic procedure provided successful treatment of early vocal cord cancer in 59 (86%) of the 69 patients. The initial success rate together with "salvage" treatment modalities reached 96% (66/69 patients).Endoscopic laser surgery resulted in a decrease in voice intensity and phonatory duration from near normal to mildly abnormal. Voice preservation succeeded in 97% of all patients. Thus, the data demonstrate that endoscopic laser surgery is a useful modem method of therapeutic endoscopy for early vocal cord carcinoma.KEY WORDS: CO2 laser, microsurgical endoscopy, results of cordectomy, vocal cord cancer INTRODUCTIONThe transoral removal of carcinoma including vocal cord lesions was generally criticized in the US and Europe until the early 1970s (Martin, 1958;Kleinsasser, 1968). Because the fear of tumor dissemination, the procedure was considered unsound by oncologists. There is no doubt that endoscopic treatment of early vocal cord carcinoma is not a new concept; the concept of endoscopic laser excision gained acceptance after 1972 (Strong and Jak6, 1972).The value and safety of the CO2 laser in laryngeal microsurgery has been well documented for the management of nonmalignant lesions and selected cases of early carcinomas (Jak6, 1972;Davis et al., 1982;McGuirt and Browne, 1991). Sophisticated details of the limitations of laser excision were recognized, and experience in its use resulted in improvement of the indications. Advocates agree that this technique represents a "laser excisional biopsy" for a mid-vocal-cord tumor with no involvement of the anterior commissure, vocal process, ventricle, or subglottic larynx (Shapshay et al., 1990 This report examines the problems associated with the transoral excision of vocal cord carcinoma and laser technology and reports our experience in the excision of this lesion using microendoscopically controlled laser surgery. (Figure 3 A, (Figure 1 A). Therapy for all but two patients consisted of laser excision of the vocal cord lesion, followed by vaporization of adjacent and deepertissues that appeared doubtful through the operating microscope. Hemostasis was sufficient during the operation in most patients, but there were some cases in which cauterization of the paraglottic artery was necessary. MATERIALS AND METHODS Patients Surgical TechniqueFamiliarization with the practicability of endoscopic laser dissection in relation to the vocal cord lesions lead to classification ofthe following subgroups ofendoscopic cordectomy: 1) Glottic lesions limited to the sur...

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A study was performed with laryngo-microscopic CO2 laser surgery on 55 patients suffering from histologically verified glottic cancer. They were treated by either "superficial laser chordectomy", or "partial cordectomy", "total chordectomy", or "extended chordectomy" in stages Tis = 7, T1a = 34, T1b = 11, and T2 = 3. All patients with Tis remained free of tumours, in stage T1a 88% (30/34) of the patients after laser chordectomy and 2 patients after partial- and total laryngectomy. In stage T1b the recurrence rate was higher (3/11 = 27%), but 2 patients after partial laryngectomy, and one patient after radiotherapy have become tumour-free, and thus all patients in this group are free from tumours. One of the 3 patients in stage T2 developed a local tumour recurrence, but after partial laryngectomy he is free from tumour and hence all 3 patients are still alive. Laser chordectomy proved a sufficient therapeutic procedure in 47 (85%) of 55 patients; eventually 95% of the patients became tumour-free. The authors emphasise that CO2 laser chordectomy is a modern and useful surgical method in the therapy of a vocal cord carcinoma, provided adequate follow-up and the possibility of "salvage" surgery are available.

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