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Follow-up of 141 Patients

Heinrich Iro, MD; Frank Waldfahrer, MD; Annelore Altendorf-Hofmann, MD; Manfred Weidenbecher, MD; Rolf Sauer, MD; Wolfgang Steiner, MD

Arch Otolaryngol Head Neck Surg. 1998;124:1245-1250.

Objective  To determine the role of transoral laser resection of supraglottic carcinomas.

Design  Retrospective unicenter study of the oncologic results of transoral carbon dioxide laser microsurgery for supraglottic carcinomas performed between February 1979 and December 1993. Median follow-up was 37 months.

Setting  University hospital academic tertiary referral center.

Patients  We reviewed the medical records of 141 patients (a consecutive sample of 131 men and 10 women; mean age, 60 years) with histologically proven supraglottic carcinomas undergoing transoral laser surgery, possibly in combination with neck dissection or radiotherapy. Stage distribution of patients was as follows: stage I, 23.4%; stage II, 25.5%; stage III, 16.3%; and stage IV, 34.8% (according to the Union Internationale Contre le Cancer staging system).

Main Outcome Measures  Recurrence-free survival rates and local and regional recurrence rates.

Results  Five-year recurrence-free survival rates were as follows: the whole case load, 65.7%; stage I, 85.0%; stage II, 62.6%; stage III, 74.2%; and stage IV, 45.3%, according to the Union Internationale Contre le Cancer staging system. The local and regional recurrence rates were 16.3% and 9.9%, respectively.

Conclusions  The oncologic results of transoral carbon dioxide laser surgery are satisfying if clean surgical margins (R0 resection) can be reached. In patients in whom tumor-free margins are not achieved (R1 and R2 resection) and transoral revision is not possible, transcervical procedures (partial or total laryngectomy) should be performed. The indication for transoral supraglottic laryngectomy in T3 lesions should be considered with restraint.

From the Department of Otorhinolaryngology–Head and Neck Surgery, Saarland University, Homburg (Drs Iro and Waldfahrer); the Tumor Registry (Dr Altendorf-Hofmann) and the Departments of Otorhinolaryngology– Head and Neck Surgery (Dr Weidenbecher), and Radiation Oncology (Dr Sauer), University of Erlangen-Nuremberg, Erlangen; and the Department of Otorhinolaryngology–Head and Neck Surgery, University of Goettingen, Goettingen (Dr Steiner), Germany.

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