| ObjectiveTo compare the clinical efficacy of CO2 laser surgery,radiofrequency ablation,traditional open surgery,and laser combined with radiofrequency ablation in the treatment of early glottic laryngeal carcinoma and explore the value of laser combined with radiofrequency ablation.MethodsOne hundred and nine patients who underwent surgery for early glottic laryngeal carcinoma between July 2012 and May 2020 were retrospectively reviewed.According to the patient’s surgical methods,it can be divided into CO2 laser surgery group(laser group),radiofrequency ablation group(ablation group),traditional open surgery group(open group),and laser combined with radiofrequency ablation group(combination group).The patients’ age ranged from 44-83 years old.Of the 109 patients,101 were male,and 8 were female.Fifty-nine patients were smokers and 50 were nonsmokers.The lesions of 65 patients were staged as T1 and those of 44 as T2.There were 12 cases of poorly differentiated squamous cell carcinoma,70 cases of moderately differentiated squamous cell carcinoma,and 27 cases of highly differentiated squamous cell carcinoma.Among 109 patients,the anterior commissure was involved in 46 cases.After 3 years of follow-up,we analyzed the operation status,survival and recurrence of patients with different surgical methods to evaluate the clinical efficacy.Results1.The mean operation time of the laser group was 121.61±51.23 minutes,126.71 ±60.63 minutes in the ablation group,172.41 ±68.67 minutes in the open group,and 122.00±31.99 minutes in the combination group.The average operation time of the open group was longer than that of the laser group and combination group(p=0.008<0.05).The mean duration of hospitalization after surgery in the laser group was 5.90±3.02 days,3.92±2.26 days in the ablation group,11.19±4.22 days in the open group,and 3.50±1.84 days in the combination group.The average length of hospitalization after surgery in the open group was longer than that in the laser group,ablation group,and combination group.And the average length of hospitalization after surgery in the laser group was longer than that in the ablation group and combination group(p=0.000<0.05).2.There was no significant difference in the incidence of postoperative complications among the four groups.3.The 3-year overall survival was 92.7%in the laser group,93.8%in the ablation group,87.5%in the open group,and 85.7%in the combination group.But the between-group difference was not significant.The difference in the 3-year overall survival of the early glottic laryngeal carcinoma between the two types of age groups(≤60 years old/>60 years old)was statistically significant(p=0.025<0.05).The Cox multivariate analysis suggested that age.T stage,and anterior commissure involvement were independent risk factors for prognosis.4.Among these patients with anterior commissure involvement,the recurrence rates during one-year follow-up were 41.2%in the laser group,25.0%in the ablation group,0.0%in the open group,and 20.0%in the combination group(p=0.020<0.05).And the recurrence rates during the three-year follow-up were 47.1%in the laser group,37.5%in the ablation group,6.3%in the open group,and 20.0%in the combination group(p=0.047<0.05).The three-year relapse-free survival was 52.9%in the laser group,62.5%in the ablation group,93.8%in the open group,and 80.0%in the combination group(p=0.047<0.05).These between-group differences were significant.Conclusions1.Laser combined with radiofrequency ablation can effectively shorten the length of operation and hospital stay and recover more quickly.2.The oncological outcome of early glottic laryngeal carcinoma is good.The association between surgical methods and three-year overall survival of early glottic laryngeal carcinoma was not significant.3.It is significant to choose the optimal surgical methods for the early glottic laryngeal carcinoma with anterior commissure involvement.4.For the early glottic laryngeal carcinoma with anterior commissure involvement,laser combined with radiofrequency ablation had a lower recurrence rate and higher relapse-free survival.Among these microsurgeries,laser combined with radiofrequency ablation is the most effective treatment for early stage glottic laryngeal carcinoma. |
PDF Full Text Request