TRANSORAL LASER-SURGERY OF SUPRAGLOTTIC CANCER - FOLLOW-UP OF 141 PATIENTS

Objective: To determine the role of transoral laser resection of supra glottic carcinomas. Design: Retrospective unicenter study of the oncol ogic results of transoral carbon dioxide laser microsurgery for suprag lottic carcinomas performed between February 1979 and December 1993. M edian follow-up was 37 months. Setting: University hospital academic t ertiary referral center. Patients: We reviewed the medical records of 141 patients (a consecutive sample of 131 men and 10 women; mean age, 60 years) with histologically proven supraglottic carcinomas undergoin g transoral laser surgery, possibly in combination with neck dissectio n or radiotherapy. Stage distribution of patients was as follows: stag e I, 23.4%; stage II, 25.5%; stage III, 16.3%; and stage IV, 34.8% (ac cording to the Union Internationale Contre le Cancer staging system). Main Outcome Measures: Recurrence-free survival rates and local and re gional recurrence rates. Results: Five-year recurrence-free survival r ates were as follows: the whole case load, 65.7%; stage I, 85.0%; stag e II, 62.6%; stage III, 74.2% and stage IV, 45.3%, according to the Un ion Internationale Contre le Cancer staging system. The local and regi onal recurrence rates were 16.3% and 9.9%, respectively. Conclusions: The oncologic results of transoral carbon dioxide laser surgery are sa tisfying if clean surgical margins (RO resection) can be reached. In p atients in whom tumor-free margins are not achieved (R1 and R2 resecti on) and transoral revision is not possible, transcervical procedures ( partial or total laryngectomy) should be performed. The indication for transoral supraglottic laryngectomy in T3 lesions should be considere d with restraint.