Surgical margins and prognosis in the treatment of laryngeal carcinoma with CO2 laser
DOI:
https://doi.org/10.34631/sporl.3085Keywords:
Transoral microsurgery using CO2 laser, Glottic carcinoma, Local control, RecurrenceAbstract
Introduction: Surgical treatment of laryngeal cancer has evolved in recent decades to preserve organ function without compromising oncological safety. Transoral microsurgery with CO2 laser (TLM) has been widely adopted in the early stages of laryngeal cancer due to its effectiveness in tumor resection and organ preservation. However, the narrower safety margins compared to open techniques may increase the risk of local recurrence, highlighting the importance of close follow-up and identifying prognostic factors that influence local control and recurrence.
Objectives: The study aimed to identify prognostic factors associated with local control and recurrence in patients undergoing TLM for the treatment of laryngeal cancer.
Material and Methods: Patients with T1-T2 glottic carcinoma treated between 2013 and 2022 were included. Variables related to patient (age, gender, comorbidities, biomarkers), tumor (extent, staging, anterior commissure involvement) and treatment (surgical margins, need for adjuvant therapy) were assessed. Immediate local control (ILC) was defined by achieving negative margins after TLM. Complete local control (CL2) was defined as achieving local control with TLM as the only therapeutic intervention, regardless of the number of procedures performed, at least two years after the first procedure. Statistical analysis included univariate tests and binary logistic regression.
Results: 51 patients were analyzed (mean age 64.2 years), with CLi and CL2 rates of 52.9% and 82.4%, respectively, and an organ preservation rate of 94.1% at two years. CLi was significantly associated with early-stage tumors and without supra/subglottic involvement, with p-values of 0.005 and 0.033, respectively. Regarding CL2, it showed a significant association with lower platelet/lymphocyte ratio, absence of anterior commissure involvement, early-stage tumors and lower alcohol consumption, with p-values of 0.049, 0.039, <0.001 and 0.039, respectively. Binary logistic regression analysis confirmed these associations, highlighting that CLi was significantly associated with early-stage tumors (OR: 8.68; 95% CI: 1.35-101.41; p = 0.047), while CL2 was associated with both early-stage tumors (OR: 57.24; 95% CI: 4.13-793.09; p = 0.003) and lower platelet/lymphocyte ratio (OR: 0.99; 95% CI: 0.99-0.999; p = 0.019).
Conclusions: TLM was shown to be effective and safe in the treatment of laryngeal cancer, with high rates of disease control and organ preservation. Factors such as tumour staging and platelet/lymphocyte ratio had a significant impact on outcomes. Careful assessment of these factors can optimize the treatment and follow-up of these patients.
Downloads
References
Sievert M, Goncalves M, Zbidat A, Traxdorf M, Mueller SK, Iro H. et al. Outcomes of transoral laser microsurgery and transoral robotic surgery in oropharyngeal squamous cell carcinoma. Auris Nasus Larynx. 2021 Apr;48(2):295-301. doi: 10.1016/j.anl.2020.08.019.
Korkmaz MH, Bayır Ö, Hatipoğlu EB, Tatar EÇ, Han Ü, Öcal B. et al. Oncological outcomes of transoral laryngeal microsurgery with fiber-optic diode laser for early glottic cancer: a single-center experience. Eur Surg Res. 2022;63(3):132-144. doi: 10.1159/000519718
Fiz I, Koelmel JC, Sittel C. Nature and role of surgical margins in transoral laser microsurgery for early and intermediate glottic cancer. Curr Opin Otolaryngol Head Neck Surg. 2018 Apr;26(2):78-83. doi: 10.1097/MOO.0000000000000446.
Liang F, Xiao Z, Chen R, Han P, Lin P, Huang Y. et al. Transoral 980-nm/1470-nm dual-wavelength fiber laser microsurgery for early-stage glottic carcinoma. Oral Oncol. 2019 Sep:96:66-70. doi: 10.1016/j.oraloncology.2019.07.007
Mariani C, Carta F, Bontempi M, Marrosu V, Tatti M, Pinto V. et al. Management and oncologic outcomes of close and positive margins after transoral CO(2) laser microsurgery for early glottic carcinoma. Cancers (Basel). 2023 Feb 27;15(5):1490. doi: 10.3390/cancers15051490.
Zhong A, Xu X, Fan H, Wang L, Niu Y. Transoral laser microsurgery for recurrent laryngeal carcinoma: A systematic review. J Cancer Res Ther. 2015 Oct:11 Suppl 2:C173-8. doi: 10.4103/0973-1482.168180.
Canis M, Ihler F, Martin A, Wolff HA, Matthias C, Steiner W. Organ preservation in T4a laryngeal cancer: is transoral laser microsurgery an option? Eur Arch Otorhinolaryngol. 2013 Sep;270(10):2719-27. doi: 10.1007/s00405-013-2382-7.
Breda E, Catarino R, Monteiro E. Transoral laser microsurgery for laryngeal carcinoma: survival analysis in a hospital-based population. Head Neck. 2015 Aug;37(8):1181-6. doi: 10.1002/hed.23728.
Pantazis D, Liapi G, Kostarelos D, Kyriazis G, Pantazis TL, Riga M. Glottic and supraglottic pT3 squamous cell carcinoma: outcomes with transoral laser microsurgery. Eur Arch Otorhinolaryngol. 2015 Aug;272(8):1983-90. doi: 10.1007/s00405-015-3611-z.
Chone CT, Yonehara E, Martins JE, Altemani A, Crespo AN. Importance of anterior commissure in recurrence of early glottic cancer after laser endoscopic resection. Arch Otolaryngol Head Neck Surg. 2007 Sep;133(9):882-7. doi: 10.1001/archotol.133.9.882.
Peretti G, Piazza C, Penco S, Santori G, Del Bon F, Garofolo S. et al. Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers. Head Neck. 2016 Jul;38(7):1107-12. doi: 10.1002/hed.24424.
Eckel HE, Thumfart W, Jungehülsing M, Sittel C, Stennert E. Transoral laser surgery for early glottic carcinoma. Eur Arch Otorhinolaryngol. 2000;257(4):221-6. doi: 10.1007/s004050050227.
Hoffmann C, Cornu N, Hans S, Sadoughi B, Badoual C, Brasnu D. Early glottic cancer involving the anterior commissure treated by transoral laser cordectomy. Laryngoscope. 2016 Aug;126(8):1817-22. doi: 10.1002/lary.25757.
Vilaseca I, Nogués-Sabaté A, Avilés-Jurado FX, Berenguer J, Grau JJ, Verger E. et al. Factors of local recurrence and organ preservation with transoral laser microsurgery. Head Neck. 2019 Mar;41(3):756-764. doi: 10.1002/hed.25422.
Wilkie MD, Lightbody KA, Lythgoe D, Tandon S, Lancaster J, Jones TM. Transoral laser microsurgery for early and moderately advanced laryngeal cancers. Eur Arch Otorhinolaryngol. 2015 Mar;272(3):695-704. doi: 10.1007/s00405-014-3011-9.
Forner D, Rigby MH, Hart RD, Trites JR, Taylor SM. Oncological and functional outcomes following transoral laser microsurgery in T2a vs T2b glottic squamous cell carcinoma. J Otolaryngol Head Neck Surg. 2019 Jun 7;48(1):27. doi: 10.1186/s40463-019-0346-7.
Ambrosch P. The role of laser microsurgery in the treatment of laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg. 2007 Apr;15(2):82-8. doi: 10.1097/MOO.0b013e3280147336.
Canis M, Ihler F, Martin A, Wolff HA, Matthias C, Steiner W. Results of 226 patients with T3 laryngeal carcinoma after treatment with transoral laser microsurgery. Head Neck. 2014 May;36(5):652-9. doi: 10.1002/hed.23338.
Li Z, Qu Y, Yang Y, An W, Li S, Wang B. et al. Prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index in patients with laryngeal squamous cell carcinoma. Clin Otolaryngol. 2021 Mar;46(2):395-405. doi: 10.1111/coa.13689.
Zwakenberg MA, Westra JM, Halmos GB, Wedman J, van der Laan BFAM, Plaat BEC. Narrow-band imaging in transoral laser surgery for early glottic cancer: A Randomized Controlled Trial. Otolaryngol Head Neck Surg. 2023 Sep;169(3):606-614. doi: 10.1002/ohn.307
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Pedro Gomes, Diogo Cunha Cabral, José Ferreira Penêda, André Alves Carção, Delfim Duarte, Gustavo Lopes
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
