A single transoral laser microsurgery to simultaneously diagnose and treat early glottic cancer and premalignancies

Transoral laser microsurgery (TLM) for early glottic cancer is often performed after pathological diagnosis is obtained by a biopsy, requiring two separate procedures. Single-stage TLM (SSTLM), both diagnostic and curative in one surgery, may be an alternative strategy. This retrospective cohort study enrolled patients diagnosed with early glottic cancer (T1/T2), carcinoma in situ (CIS), or severe dysplasia (SD) after TLM at a tertiary center between 2012 and 2021. The patients were classified into two groups: the two-stage TLM (TSTLM) group had first received biopsy before the definitive TLM; the SSTLM group underwent TLM directly. In TSTLM group, the pathological results by biopsy were compared to those by TLM. Clinical characteristics and outcomes between the two groups were compared. 128 patients were included: 68 in SSTLM group, and 60 in TSTLM group. In TSTLM group, 20 (33%) had inconsistent pathological results between biopsy and TLM; 15 (25%) presented with underdiagnosis in biopsy. Compared to TSTLM group, SSTLM group had significantly older age (65 vs. 61; p = 0.024), smaller T stages, and received smaller cordectomies. No significant differences in margin status, repeat TLM (28% vs. 20%; p = 0.295), 5-year overall survival (81% vs. 82%; p = 0.38), and 5-year local control (81% vs. 86%; p = 0.92) were found between the two groups. Biopsy surgery for early glottic cancer or glottic premalignancies has unreliable results. In selected cases, SSTLM is an effective management for suspected early glottic cancer, especially in older patients and more limited lesions.