Endoscopic CO2 laser treatment of supraglottic carcinoma

Aim of the study was to evaluate whether laser endoscopic microsurgery is a reliable and appropriate approach to treatment of laryngeal supraglottic cancer. A retrospective study was made of 12 patients (11 M/1 F; mean age 62.5 years) treated from December 1995 to October 2001 in the Department of Surgical Sciences and Organ Transplantations, Section of Otorhinolaryngology, University of Cagliari, Italy. Surgical steps and oncologic results are reported. These 12 patients with supraglottic cancer underwent transoral laser surgery (TNM classification: T1, 3 patients; T2, 9 patients; N-, 9 patients; N+, 3 patients; M-, 12 patients). On the basis of the different subsites removed, the following resections were performed: 1 limited excisional biopsy (false chord), 3 wide excisional biopsies (2 or 3 subsites), 2 simple epiglottectomies, 1 extended epiglottectomy, 3 horizontal supraglottic laryngectomies, and 2 horizontal supraglottic laryngectomies that were extended to the anterior commissure and to one arytenoid, respectively. Five patients underwent functional neck dissection, and one patient underwent post-operative radiotherapy at sites of tumour and lymph nodes. Temporary tracheotomy was carried out in 10 patients. Mean follow-up was 33.3 months. No local recurrences were noted. Local control was thus 100%. Aspiration was the main post-operative problem, but there were no cases of aspiration-associated pneumonia. Moreover, no patient needed laryngectomy or a permanent tracheotomy for aspiration. In conclusion, although our experience with supraglottic cancers treated by endoscopy is still too limited to confirm the definitive oncologic validity of this type of surgery, in our hands, it seems to be a reasonable tool in selected cases and a safe, time- and cost-effective alternative to traditional surgery or radiotherapy for selected supraglottic carcinomas.