Oncological and functional results of CO2 laser cordectomy

Laser surgery represents the evolution of endoscopic surgery and, as far as concerns treatment of laryngeal tumours, CO2 laser cordectomy is considered a valid alternative to conventional surgery (laryngofissure cordectomy) and to exclusive radiotherapy for glottic carcinomas, classified as T1a, T1b and T2. The present report focuses on personal experience with CO2 laser cordectomy over the last 11 years, evaluating oncological and functional results. Between October 1990 and December 2001, micro-laryngoscopy has been performed with CO, laser, in 606 cases (benign and malignant lesions), of which 150 laser cordectomies, at the ORL Department, Eastern Piedmont University of Novara. An analysis is made of 63 patients (mean age 64.3 years) who underwent laser cordectomy for glottic carcinoma, observed at follow-up for at least 3 years. Vocal function has been studied on a sample of 20 patients. Of those who underwent CO2 laser cordectomy for T1a and T1s, 95.8% were disease free after a minimum of 3 years follow-up. Video-larynx-stroboscopic test highlighted the presence of a "satisfying" fibrous neocord in cases treated with Type III cordectomy. The speech compensation was of the "cord-neocordal" type (35%), false cordal (40%) and with arytenoideus hyperadduction (25%). The electro-acoustical analysis of the voice highlighted a "serious dysphonia" compatible with Type IV cases according to Yanagihara (70%) and moderate-severe dysphonia (30%). Mean values of vocal parameters were 5.8% for Jitter, 12.2% for Shimmer, 0.34 for NHR. CO2 laser cordectomy is first choice treatment for T1a glottic carcinoma, offering intra- and post-operative advantages: reduced traumatism, lack of tracheostomy, low bleeding, fast functional recovery (deglutition and speech), brief hospital stay, and low management costs. Dysphonia resulting from treatment, characterised by breathed voice, allows the patient to lead a normal life.