Abstract
Background.
The aim of the study was to evaluate the effectiveness of endoscopic CO~2~ laser microsurgery in the management of supraglottic cancer.
Methods.
One hundred twentyβfour patients (116 men and eight women; mean age, 59 years; range 31β81 years) with supraglottic cancer underwent CO~2~ laser surgery (mean followβup 5 years). The study patients were classified as follows: 45 patients, T1N0M0; 61 patients, T2N0M0; and 18 patients, T3N0M0. According to the staging, the following procedures were adopted: epiglottectomy, resection of aryepiglottic fold or false vocal cord in T1 patients (group A); resection of the false vocal cord and adjacent structures in T2 patients (group B); and supraglottic laryngectomy in T3 patients (group C). Statistical comparison of survival parameters was carried out with Wilcoxon test, considering p < .05 the minimum significance value.
Results.
Overall actuarial survival, adjusted actuarial survival, and no evidence of disease at 5 years were 91%, 97%, and 82% in group A; 88%, 94%, and 59% in group B; and 81%, 81%, and 51% in group C, respectively. The statistical analysis of survival parameters showed a significant difference in the comparison of T1 versus T2 and T2 versus T3 tumors (p < .01). Actuarial local control, actuarial nodal control, and actuarial distant metastasis control at 5 years were 82%, 82%, and 100% in T1 patients; 63%, 90%, and 98% in T2 patients; and 77%, 75%, and 93% in T3 patients. Laryngeal preservation rate was 88.6% in T1 patients, 85.4% in T2 patients, and 93.7% in T3 patients. Patients in groups A and B were discharged after 3 to 12 days, and patients in group C, were discharged after 14 to 20 days.
Conclusions.
The results of this study show that endoscopic CO~2~ laser surgery is highly effective in the treatment of T1 and T2 supraglottic cancer. In T3 cancer, the CO~2~ laser should be implemented in those cases where radical excision by endoscopic route is feasible. Β© 2004 Wiley Periodicals, Inc. Head Neck 26: 442β446, 2004