T1-T2-T3 glottic tumors: fifteen years experience with CO2 laser

This research aims at reporting the results of endoscopic treatment of glottic carcinomas by CO2 laser. The cases cited concern 516 patients with glottic T1-T2-T3 carcinomas. The patients have been divided into 5 groups: a) T1a: 194 patients with monolateral carcinoma involving the true vocal cord who underwent simple cordectomy; b) T2a: 104 patients with monolateral cordal carcinoma involving the ventricle and the false cord; c) T1b: 127 cases of monolateral or bilateral carcinoma involving the anterior commissure; d) these patients underwent bilateral cordectomy; T2b: 54 cases of monolateral or bilateral carcinomas involving the anterior commissure and extending to the hypoglottic or supraglottic region; in these patients a bilateral extended cordectomy was performed; e) T3: 37 selected cases of monolateral or bilateral cordal carcinoma with fixed vocal cord, fixity was due to the substantial size of the tumor or to the infiltration of the paraglottic space; these patients underwent a monolateral or bilateral extended cordectomy. The following are the results at 5 years: group a: overall observed survival rate (OSR) was 79% and the adjusted survival rate (ASR) 94.5%; group b: OSR 67% and ASR 77%; group c: OSR 88.4% and ASR 96.5%; group d: OSR 82% and ASR 90%; group e: OSR 55% and ASR 67%. The above data are evidence of the fact that our surgical techniques offer similar or better advantages in terms of survival rate compared to the traditional procedures. It must be noted that endoscopic surgery of glottic tumors carried out by CO2 laser offers relevant benefits when compared with traditional surgery: i) rapidity of operation and reduced surgical trauma; ii) the possibility of avoiding tracheotomy; iii) the respect of the integrity of the cartilaginous skeleton; iv) short postoperative course and low incidence of complication; v) better functional results; vi) a shorter stay in hospital with positive psychological effects on the patients and lower social costs.