Results of curative laser microsurgery of laryngeal carcinomas

Between 1979 and 1991 the author treated more than 1,200 patients with malignant tumors of the upper-aerodigestive tract transorally using laser microsurgery with curative, palliative, or symptomatic intention.

This report is based on 240 patients without prior treatment, treated between 1979 and 1985 with curative intention for cancer of larynx (pTis-pT4 (p)N0-pN2c). Patients with simultaneous second primaries and/or distant metastases were excluded. Neck metastases of the category N3 (UICC 1987) were not found in the group. Patients were divided into two groups. Group A (n = 159) includes glottic cancer as follows: Tis, 29; T1, 96; T2 (small, vocal cord mobile), 34. All patients were treated by laser microsurgery. There were only 6% local recurrences with one patient needing total laryngectomy. The overall 5-year survival rate (Kaplan-Meier) was 86.5%. The adjusted 5-year survival rate was 100%. The group B patients (n = 81) included 30 supraglottic patients. Fifty-eight patients were in tumor category pT2, among them there were 38 with glottic cancer (so called T2b, with vocal cord mobility impaired). Seventeen patients had pT3 and 6 pT4 tumors.

Treatment consisted of laser microsurgery plus/minus neck dissection (23/81 = 28%) (mainly regionally limited functional surgery, only four radical neck dissections) plus/minus postoperative radiotherapy (29/81 = 35%). There were 22% local recurrences with six patients requiring total laryngectomy. The overall 5-year survival rate (Kaplan-Meier) was 59%.

This study confirms the usefulness of laser microsurgery for laryngeal carcinoma. Surgery is individualized and adapted to the size of the tumor. Multiinstitutional studies are needed to compare laser microsurgery with radiation therapy.