Is There a Change in the Treatment of T1 Glottic Cancer After CO2 Laser? A Comparative Study with Cold Steel

Abstract

Objective: Carbon dioxide (CO2) laser provides highlocal control and disease-specific survival rates withminor morbidity and good quality of life in transoralcordectomy. We aimed to compare the oncologicaloutcome and survival between cold steel and CO2 laser in the treatment of early glottic cancer.Methods: In this retrospective study, the participantswere divided into two groups. The first group comprised patients who were operated upon between 2001and 2007 using cold steel (group 1, n=38), and thesecond group comprised patients who were operatedupon between 2008 and 2016 using CO2 laser (group2, n=88). Both groups were compared regarding age,gender, pathological grade, T stage, type of cordectomy, margin status, anterior commissure involvement, follow-up, locoregional recurrence, and disease-free survival (DFS).Results: The overall survival rate and DFS were similar between the two groups (94.7% vs. 98.9% and100% vs. 98.9%, respectively), and no association wasfound between surgical margin positivity and local recurrence. However, a significant association betweenthe presence of anterior commissure involvement andrecurrence was found in all 126 patients (p=0.016).Local recurrence was significantly higher in the group2 (p=0.024), but it did not affect overall survival andDFS in these patients (100% vs. 94.1%).Conclusion: Although CO2 laser excision is considered to be superior to cold steel regarding surgical timeand bleeding control, the local recurrence rates werefound to be higher with the laser than the cold steel. Thus, we argue that cases should be selected morecarefully concerning the anterior commissure, depthof tumor invasion lateral to vocal muscle, difficulty atendoscopic exposure for lesions with anterior commissure involvement, and reliability of surgical margins at frozen sections.