Surgical therapy of Ti and selected cases of T2 glottic carcinoma: Cordectomy, horizontal glottectomy and CO2 laser endoscopic resection

Aims and background: Among the different laryngeal neoplasms, glottic carci noma is known to be one of the most suitable for functional management, Nev ertheless, the best treatment for T1 and T2 glottic carcinoma, whether an o pen neck procedure, endoscopy or radiotherapy, with reference to recurrence , survival, and functional results, has long been debated. Study design: From February 1983 to September 1997, 83 patients with well t o undifferentiated glottic carcinoma (48 pT1a, 14 pT1b, and 21 selected cas es of pT2 with impairment of vocal cord mobility) were submitted to surgery at the Otorhinolaryngologic Section of the Department of Surgical Sciences and Organ Transplantations of Cagliari University. Surgical treatment incl uded 30 laryngofissures with simple or enlarged cordectomy, 22 horizontal g lottectomies and 31 endoscopic laser resections. A retrospective review of the records of the patients was performed in order to obtain a better under standing of the outcome of the three different surgical procedures in our i nstitution. Results: According to the Kaplan-Meier method, the probability of remaining free of local recurrence 3 years after primary surgery was 0.90 for the T1 group and 0.85 for the T2 group. the distribution of recurrences for corde ctomy, glottectomy and CO2 laser at 3 years showed a cumulative probability of remaining free of disease after primary surgery of 0.86, 0.85 and 0.88. The probability of remaining free of local recurrence 3 years after salvag e surgery was 0.96 for the T1 group and 0.95 for the T2 group. Analyzing th e phenomena for type of surgical procedure, local control at 3 years after salvage surgery for cordectomy, glottectomy and exclusive CO2 laser was 0.9 3, 0.90 and 0.92, respectively. In the endoscopic group, local control rate after any type of salvage therapy modified the percentage at 3 years to 10 0%. Anterior commissure spread (AC1-AC2) resulted in a difference (not stat istically significant) in local control between the group of patients witho ut and with anterior commissure involvement. Laryngeal preservation was ach ieved in 93.7% (45/48) of patients who survived after salvage surgery follo wing open neck procedures and in 100% of patients originally submitted to t he endoscopic approach. Conclusions: In our experience, although open laryngeal procedures can be s till considered a valid option in the treatment of T1 and selected cases of T2 glottic carcinoma, endoscopic laser excision offered an oncologically a dequate alternative to the traditional techniques, with minimum discomfort for the patient and satisfactory preliminary functional results.