Single Stage Transoral Laser Microsurgery for Early Glottic Cancer

Abstract

Objectives: The purpose of the study was to present the outcome of our management protocol of a single stage transoral laser microsurgery (SSTLM), with the intention of complete removal of a lesion, considered to be an early glottic cancer. Methods: Between January 2015 to February 2017 patients with the clinical appearance of an early glottic cancer, who were candidates for (SSTLM) management protocol, were included in this study. Type of cordectomy was determined by pre- and intra-operative evaluation of the extent of lesion in cord layers. Results: Thirty patients (6 females, 24 males; mean age 65 years) underwent SSTLM. Twenty-two patients had malignant histopathological diagnosis of severe dysplasia or Cis in 4 patients, microinvasice carcinoma in 3 patients and invasive carcinoma in 15 patients (T1a tumor in 14 and T1b tumor in 1). Eight patients had a nonmalignant histological diagnosis of keratosis without atypia in 2 patients, mild dysplasia in 2 patients and moderate dysplasia in 3 patients. Based on pre- and intra-operative evaluation, 14 subepithelial (type I), 10 subligamental (type II), and 6 transmuscular (type III) cordectomies were performed. Comparison of cordectomies types with postoperative histopathologic diagnosis showed an adequate extent of resection in 26 out of 30 patients (87%). Considering only patients without recent background of direct laryngoscopy and biopsy, an adequate resection was performed in 90% of patients. None of the patients was further treated by external beam radiation. At average follow-up of 21 months, none of the patients developed local recurrence. Conclusion: In selected cases, a SSTLM for clinical appearance of an early glottic cancer, allows a reliable histopathologic diagnosis and a high local control rate with favorable cost effectiveness. A careful pre- and intraoperative evaluation for selecting the appropriate cases for this management is required in order to avoid under- or over-treatment.

Keywords: CO2 laser; complete removal; excisional biopsy; glottic cancer; single stage; transoral laser microsurgery.

Figure 1

Microinvasive SCC of the right vocal cord. (A, B) Endoscopic view with 0 and 70-degree endoscopes. Note limited involvement of anterior commissure, no extension into ventricle or subglottic area. (C, D) Microscopic view before and after mucoligamentous hydrodissection by injection of saline solution into Reinke's space. Note no adherence of the mucosa to the ligament, suggesting lesion limited to the mucosa. (E) A narrow mucosal margin has been made with the laser. (F) After type I cordectomy, the deep plane of excision is the vocal ligament, which is clearly exposed. (G) Pathological specimen pinned on a carrier substance, oriented, and mapped by marking directions and surrounding glottic structures.