Transoral endoscopic CO2 laser microsurgery for early laryngeal cancers.

BACKGROUND The impact of transoral endoscopic CO(2) laser microsurgery (TLM) for the treatment of Tis, T1, and T2 glottic cancer on local disease control, survival, and laryngeal preservation was investigated. METHODS From October 1999 to February 2008, 48 patients with a previously untreated early laryngeal malignant tumor who had been treated with TLM were enrolled in this study. Overall survival, primary and ultimate local control, and larynx preservation rates were calculated by the Kaplan-Meier method. The impact of anterior commissure involvement on the local control rate after primary TLM was performed was analyzed by the log-rank test. Functional results for postoperative voice were analyzed by patient telephone intelligibility. RESULTS The overall 5-year survival rate was 97% (95% CI, 94%-100%), the primary 5-year local control rate was 72% (95% CI, 66%-92%), the local control rate exclusively for TLM was 85% (95% CI, 79%-99%), and the ultimate 5-year local control rate was 100%. Larynx preservation rate was 97% (95% CI, 94%-100%). Anterior commissure involvement in glottic cancer showed no statistically significant difference in primary local control rate (p = 0.9). Regarding the post-operative voice function, 47 patients (97.9%) were able to maintain adequate telephone intelligibility. CONCLUSION In terms of long-term survival and locoregional control, TLM is an optimal primary treatment modality for early laryngeal cancer. With TLM treatment, involvement of the anterior commissure is not a poor prognostic indicator.