Clinical Outcome and Survival Analysis of Rigid Carbon Dioxide Transoral Laser Microsurgery in Glottic Squamous Cell Carcinoma of the Larynx

Objective: The aim of this study was to evaluate treatment outcomes, the recurrence and larynx preservation rates, and the survival status of patients treated with transoral laser microsurgery with a rigid carbon dioxide system for glottic squamous cell carcinoma of the larynx. Methods: Patients with squamous cell carcinoma of the glottic larynx who underwent transoral laser microsurgery using rigid carbon dioxide laser between 2008 and 2019 at a tertiary referral center were reviewed. Non- rigid laser cases and laryngeal cancers other than those affecting the glottic region were excluded. Demographic variables, tumor stage, type of cordectomy, larynx preservation rate, complications, and recurrence data were recorded. Two-, 3, and 5-year overall, disease-free, and disease- specific survival rates were calculated. Patients with recurrent tumors were reviewed in detail. Results: Two hundred six transoral laser microsurgery operations and 185 patients were treated during the study period. After exclusions, 90 transoral laser microsurgery operations and 86 patients were included. The median follow-up was 57.2 months. Tumor recurrence occurred in 16 (18.6%), including local (n = 14), locoregional (n = 1), and regional (n = 1) recurrence. The larynx preservation rate was 94.2%. The 5-year overall, disease-free, and disease-specific survival rates in Tis-T3 tumors were 93.7%, 75.5%, and 98.8%, respectively. The 5-year overall survival rates by T stage were 92.3% in Tis, 95.3% in T1, 100% in T2, and 80% in T3 tumors. Anterior commissure involvement had no significant effect on survival. En-bloc resection was achieved in 76 (88.4%). Conclusion: Excellent oncological outcomes with minimal complication rates, high survival, local control, and larynx preservation rates were achieved with transoral laser microsurgery in the treatment of glottic laryngeal cancers. Keywords: Carbon dioxide laser, glottis, larynx cancer, laser surgery, squamous cell carcinoma of the larynx