Early-Stage Glottic Cancer

Abstract

To assess local control of early-stage glottic cancer by laser cordectomy in comparison with previously published external partial laryngectomy series and to determine the relevance of histological margins in glottic cancers excised with laser cordectomy.Design: Retrospective review of laser cordectomy for carcinoma in situ (Tis) and stage T1 glottic cancer from January 1991 to January 2004.Setting: University hospital.Patients: Fifty-two patients with Tis or T1 glottic cancer.Intervention: Endoscopic laser cordectomy, classified using the system proposed by the European Laryngeal Society Working Committee.Main Outcome Measures: Local control after initial surgery and after salvage compared with a published historical control group, according to the type of cordectomy performed and the histological margins of the removed specimen.Results: Sixteen patients with Tis, 30 with T1a tumors, and 6 with T1b tumors were followed up for an average of 38 months. Type I cordectomy was the most common procedure used to treat Tis, and type II and type III were the most common for treating T1a and T1b tumors. Of 6 recurrences, 4 were treated with laser cordectomy and 2 were treated with external partial laryngectomy. The rate of laryngeal preservation was 100%. There were 3 recurrences despite histologically clear margins. Three (17%) of 18 patients with suspicious margins developed recurrences. The rate of local control with single intervention (46 [89%] of 52) was lower than with partial external laryngectomy. However, 46 (89%) of 52 patients ultimately had less tissue removed by laser than would have been removed by external partial laryngectomy. Conclusions:Laser cordectomy provides excellent local control and laryngeal preservation. Close follow-up of patients with positive or suspicious margins is an alternative to further routine treatment.

Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control

“…Furthermore, we cannot exclude a local variation in evaluation protocol having led to this result, and finally we cannot exclude that the pathologist reviewing the samples may have been the particularly meticulous knowing that the results would be analysed for a study. Despite the high rate of positive margins, our data are in line with the literature, showing that positive margins have no impact on local control [8, 10, 11, 16]. …”

Five-Year Outcomes of Transoral Laser Microsurgery for Early-Stage Glottic Cancer: A Single-Center Retrospective Study

“…In our cohort, Type III cordectomy was performed in 44.8% of patients, followed by Type IV in 37.5%, Type Va in 11.5%, and Type Vb in 6.3%. Compared to the ndings of Sigston et al [10], our study shows a higher proportion of Type IV and Va cordectomies among patients with stage T1 disease, which may be attributable to the greater incidence of lesions involving the anterior commissure in our population. The utilization of Type Va cordectomy in our series aligns with Peretti's description [6] for lesions extending across the anterior commissure of the vocal cords.…”

Narrow‐Band Imaging in Transoral Laser Surgery for Early Glottic Cancer: A Randomized Controlled Trial

“…The 5-year overall survival of early-stage laryngeal carcinoma reported in the literature is high: 88% to 94%, 19,24,31 and the reported 5-year disease-specific survival is even better 97% to 99%. 19,28,32 Although the survival is favorable, the recurrence rate is considerable: percentages between 10% and 31% are reported, 19,24,27,[33][34][35][36][37] which is consistent with the recurrence rate of 23% we found. The recurrence rate is largely dependent on the follow-up duration that was maintained in different studies, for instance, the recurrence rate of 31% was found in a cohort with a follow-up duration of 15 years.…”