Oncologic And Voice Analysis After Carbon Dioxide Laser Surgery For Early Glottic Carcinoma

The morbility of laryngeal carcinoma is high recent years, surgery is one of bestmethod. The development of carbon dioxide (CO₂) laser surgery for early laryngealcarcinoma change the surgery methods, the CO₂ laser surgery which is under theoperation microscope can exsect the tumors thoroughly,and also retain the frame andfunction of larynx, the trauma of the surgery is very slight, the bleeding is alsolittle,the time of anaesthesia is short, the recovery is quickly and can avoid theincision of trachea, it can make the operation become simple and easily, and achievethe best efficacy in the condition of the operation made inner larynx completely afterthe operation, the function and frame of the larynx can recover well, the patient'spronunciation can be satisfactory. It is only use for glottic carcinoma in early stage.Recently, some article report that CO₂ laser can be used to exsect supraglotticcarcinoma, even the T₃&T₄ stage. The treatment of early glottic cancer by CO₂ laserhas become the first choice.Objective: (1)Through the follow-up of the patient after the CO₂ laser surgery ofearly glottic cancer, we will get their results.(2) To analyze voice function after CO₂laser surgery of early glottic carcinoma by perceptive and objective assessmentmethods.Materials and Methods1. Retrospective analysis 112 early glottic carcinoma patients (15 T_is, 53 pT_1a, 15pT_1b, and 29 pT₂) who have done CO₂ laser surgery between October 1999 andOctober 2005.2. Five types of laser cordectomies as classified by the European LaryngologicalSociety classification were performed. Comparison of voice results between thedifferent types of cordectomies as well as with a control group was performed. Voicehandicap index (VHI) were performed in 85 patients.Results 1. According to the Kaplan-Meier method, the probability of remaining free oflocal recurrence 5 years after primary surgery was 100% for the Tis, 88.52% for theT_1a, 79.51% for T_1b and 79.02% for the T₂, without statistical significance of variousgroups by the Log-Rank tests (x²=3.467 P＞0.05). The probability of remaining free oflocal recurrence 5 years after primary surgery was 72% of tumors offended theanterior commissure, versus 90.52% with no involvement of anterior commissure,have statistical significance (x²=5.396 P＜0.05 ). The 5 year overall survival were90.24%. The probability of remaining free of local recurrence 5 years after any typeof salvage surgery was 100%.2. There was no significant difference in the voice function between subepithelialand subligamental cordectomies and controls (P＞0.05). There was, however, asignificant difference between the groups of total cordectomies and controls (P＜0.05). The VHI scores show all patients in the group of typeâ… and typeâ…¡had annormal voice or mild dysphonia and 51.8% of the patients treated with totalcordectomies had a moderate or severe dysphonia.ConclusionsThe CO₂ laser surgery of early glottic carcinoma can preserve voice function ofthe larynx and have good results. Good voice function with no difference betweencontrols and subepithelial and subligamental cordectomies support the CO₂ lasersurgery as the first choice of treatment for early glottic cancer.