Analysis of failure following transoral laser surgery for early glottic cancer

Abstract

This study aimed at clarifying further the clinical behavior of early glottic cancer following transoral laser surgery and to determine, using retrospective analysis, whether the site of tumor involvement along the vocal fold has prognostic significance. The study included all patients treated with transoral laser surgery, for early glottic cancer (T1/T2N0M0) between May 1998 and January 2012 in a university affiliated tertiary care medical center. Data on demographics, site and extent of disease, treatment and outcome were collected and analyzed. Patients with insufficient data and/or follow-up of <2 years were excluded from the study. One-hundred and twenty-one patients were eligible for the study. Mean follow up time was 6.7 years (range 2-12 years). Overall recurrence rate following primary transoral laser surgery was 16.5 %. Histological grade was associated with higher recurrence rate (p = 0.008). Anterior commissure involvement was associated with reduced disease-free survival and tumors extending to the middle third of the true vocal fold were associated with lower recurrence rate. As per the results, anterior extension of glottic tumors is associated with higher recurrence rate compared to middle vocal fold extension, presumably due to earlier detection, better visualization and different biological behavior pattern of middle vocal fold tumors. Patients with higher grade tumors should be closely monitored for disease recurrence.