Transoral Laser Microsurgery for Early Glottic Carcinoma: Laryngeal Preservation and Long-term Oncological Outcomes...

Carbon dioxide transoral laser microsurgery (CO₂TOLMS) is a well-established treatment for early-stage glottic carcinoma, offering excellent oncological control with organ preservation. This study evaluates long-term outcomes and prognostic factors in a consecutive cohort.

A retrospective analysis was performed on 161 consecutive patients with Tis-T2 glottic carcinoma treated with CO₂TOLMS between 2016 and 2021. Primary endpoints included overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), locoregional control (LRC), and laryngeal preservation. Prognostic factors were analyzed using Cox regression models.

At a median follow-up of 60.3 months, 5-year OS, DSS, DFS, and LRC were 91.9%, 98.1%, 83.2%, and 82.0%, respectively. Laryngeal preservation was achieved in 96.3% of patients. On univariate Cox analysis, T2 stage (HR 3.39, 95% CI 1.65-7.05, p = 0.003), anterior commissure involvement (HR 2.70, 95% CI 1.32-6.19, p = 0.01), and close or positive margins (HR 6.56, 95% CI 2.82-8.78, p = 0.001) were significantly associated with worse DFS. For OS, significant predictors included age >70 years (HR 3.84, p = 0.035), ASA III status (HR 3.21, p = 0.043), T2 stage (HR 4.61, p = 0.001), anterior commissure involvement (HR 3.12, p = 0.02), and margin status (HR 5.84, p = 0.001). Local recurrence occurred in 14.9% of patients, most within the first two years, and was successfully managed with repeat laser surgery in the majority of cases.

CO₂TOLMS achieves excellent oncological outcomes with high laryngeal preservation in early glottic carcinoma. Tumor stage, anterior commissure involvement, and margin status significantly influence recurrence risk, while age and comorbidity impact overall survival. Careful patient selection and structured follow-up remain essential.