External versus endoscopic approach in the surgical treatment of glottic cancer

Laryngeal carcinomas in the early stages of evolution can be treated by different therapies. In this paper we present our personal experience with T1 and small T2 laryngeal glottic cancer treated by conventional surgery and by endoscopic laser surgery. In the period 1983-1997, we saw 573 patients affected by T1 and limited T2 glottic tumours. In particular, we treated 325 case of T1a tumour, 185 T1b and 63 T2 (ventricle floor). As regards surgical techniques, we employed cordectomy by laryngofissure in 196 patients; laser cordectomy in 129 cases; widened laser cordectomy in 63 cases; fronto-lateral laryngectomies according to Leroux-Robert in 110 patients; laser cordo-commissurectomies in 37 cases; horizontal glottectomies according to Calearo-Teatini in 9 cases, and laser glottectomies in 29 patients. The average oncological results, considered for every stage and every surgical technique were 84.4% (484 cancers definitively controlled by primary surgery). For comparison of oncological and clinical results, we evaluated patients affected by tumours with similar extension that had been treated by different surgical techniques. Oncological results were similar in the two groups. In the group treated by laser surgery we found a shorter clinical course and the best possibility of salvage therapy in the case of local recurrence.