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European Archives of Oto-Rhino-Laryngology

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01-05-2018 | Laryngology

Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO₂ laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients

Authors: Filippo Carta, Fabrizio Bandino, Aurora Marta Olla, Natalia Chuchueva, Clara Gerosa, Roberto Puxeddu

Published in: European Archives of Oto-Rhino-Laryngology | Issue 5/2018

Abstract

Purpose

CO₂ laser transoral microsurgery for glottic carcinoma, when indicated, has the well-established advantages of low morbidity and positive oncological outcomes. The present study aims to determine how patient age, and tumor site could negatively impact prognosis; other variables such as the status of the margins of resection, tobacco and alcohol intake, and the grade of differentiation of the tumors have been evaluated.

Methods

This was a retrospective analysis on 261 patients with a glottic carcinoma who underwent CO₂ laser transoral microsurgery. The impact of different variables was calculated using univariate and multivariate analyses.

Results

The study included 248 males and 13 females. The median follow-up period was 4.3 years. Five-year disease-specific survival, recurrence-free survival, local control with laser alone, overall laryngeal preservation, and overall survival rates were 99.4, 92.2, 93.8, 97.6, and 85.5%, respectively. Equivalent results were observed in young and elderly patients. Patients with positive margins after CO₂ laser transoral microsurgery showed a reduced local control with laser alone. T2 patients with true subglottic spreading and patients with anterior commissure involvement of grade 3 (Rucci’s classification) experienced worse local control rates, despite free surgical margins confirmed by histology.

Conclusions

CO₂ laser transoral microsurgery is an effective and reproducible single-stage modality therapy for young and elderly patients with glottic carcinoma. Superficial close margins can be managed by a careful wait-and-see policy, while positive margins should undergo surgical enlargement. In our experience, undifferentiated tumors, true subglottic extension, and anterior commissure involvement of grade 3 were associated with worse outcomes.

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Title: Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO2 laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients
Authors: Filippo Carta
Fabrizio Bandino
Aurora Marta Olla
Natalia Chuchueva
Clara Gerosa
Roberto Puxeddu
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 5/2018
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-018-4890-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO₂ laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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