Glottic laser surgery: outcomes according to 2007 ELS classification

Abstract

The aim of the present investigation was to analyze the oncological results of a series of early stage glottic carcinomas treated with CO(2) laser-assisted endoscopic surgery. We focused on prognosis factors with significant impact on local control and disease-free survival (DFS). This retrospective study was conducted on a series of 177 consecutive patients with pT1-T2 glottic carcinomas treated with CO(2) laser-assisted endoscopic surgery in the period 2000-2007. All considered patients had at least a 24-month follow-up period (mean follow-up 49.1 ± 23.0 months). The overall survival and the disease-specific survival rates were respectively 90.8 and 98.8%. The rates of local control with primary laser surgery, ultimate local control with laser alone, and laryngeal preservation were 86.3, 94.3, and 97.7%, respectively. Arytenoids (p = 0.006) and limited subglottic involvements (p = 0.0002) have a significant impact on DFS. Endoscopic laser surgery is the gold standard in the treatment of early glottic carcinoma because of high local control rates with laser alone, day surgery modality, very low morbility, good post-operative voice quality in most of the cases, and low costs.

Transoral Laser Microsurgery in Early Glottic Lesions

“…In some studies, outcomes are outside the ranges shown above, in these cases mostly by a few percentage points. Larger variances are mainly seen in studies with <20 patients within a T categories, in which one single aberrant case will shift outcome significantly [39–41]. Aside from random variations due to small numbers, positive deviances may also indicate selection bias with the most favorable lesions being chosen for TLM whereas the larger studies included in the table above tend to consist of (near) consecutive patients.…”

The impact of laryngeal biopsy on voice outcomes: a pilot study

“…Post biopsy, however, comparison of the patient data to the control group, revealed that some perceptual and acoustic changes had occurred, with some parameters no longer significantly different to the control group performance. As such, it may be suggested that these small shifts in function may be due to the removal of tumour tissue as supported by some authors [14][15][16].…”

“…In this study, where patients underwent several punch samples and multiple biopsy procedures, a deterioration to moderate-severe dysphonia was consistently demonstrated. These aforementioned authors and others go on to suggest that the excisional biopsy is the procedure of preference since the punch biopsy may be likely to harm the vocal cords and the excisional biopsy has the dual purpose of being both diagnostic and therapeutic in a single procedure [14,16,17,24]. Claims made by these studies, however, need to be interpreted with caution since specific voice and functional outcomes were not recorded nor rigorously investigated in their study designs.…”

“…For glottic tumours, the endoscopic excisional biopsy is favourably reported since it has the dual purpose in that it is both diagnostic and optimises therapeutic outcomes in a single procedure [14,16,17]. An excisional biopsy removes the entire pathological tissue whilst endeavouring to preserve structures of the vocal cords and is argued to be superior to the punch biopsy which may harm the vocal cords [14].…”

“…In contrast, some authors suggest no difference in long term post treatment voice outcomes for patients who had undergone stripping versus a simple biopsy procedure [11,13]. Finally, several studies now suggest that the excisional biopsy should be the procedure of preference given its dual diagnostic and therapeutic purpose [14,16,17] and the potential to preserve vocal fold function [14].…”