Our experience in endoscopic CO 2 laser surgery for supraglottic carcinoma

Abstract

Objectives: This study presents the indications, general principles, contraindications, limits, and results of this modern therapeutic method. Supraglottic laryngeal carcinoma is an aggressive, with high tendency for nodal metastasis. Therefore early detection and effective treatment is of outmost importance. Open surgical procedures, primary radiotherapy, and endoscopic procedures are therapeutic alternatives, with or without neck dissection and adjuvant radiotherapy. Methods: Between 1998–2002, 24 patients with supraglottic carcinoma T1 or T2 and N0 have been treated with supraglottic laryngectomy with CO 2 laser. All patients were carefully selected using modern videoendoscopical procedures and CT scan or neck ultrasonography. Careful preoperative selection is of outmost importance for the clinical patients outcome. In the studied group, we applied horizontal supraglottic laryngectomy in 20 cases T2N0 and epiglottectomy in 4 cases T1N0. Postoperative follow-up was between 12–48 months (average, 36 months). The thracheostomy and nasogastric tube were not necessary in any case. Results: In our group we obtained the following oncological results: no evidence of disease (NED) 19 cases (79.17%), and local recurrence in 5 cases (20.83%). All patients who presented local recurrence were stage T2N0; the salvation treatment we applied consisted in total laryngectomy. Immediate functional results were very good in all cases. Conclusions: Endoscopic CO 2 laser microsurgery appears to be an effective and safe alternative treatment for T1-T2, N0 supraglottic carcinoma, with superior oncological and functional results than the other techniques, requiring short hospitalization, no tracheostomy and feeding tube, and providing superior rehabilitative result with a good quality of life.