Surgical management of stage I and II laryngeal cancer using laser microsurgery and bioengineering technology

Treatment of patients with T1-2N0M0 glottic laryngeal cancer (GLC) involves organ preservation. Endolaryngeal laser microsurgery is gaining support and claims to become the method of choice in the treatment of early stages of GLC. The paper presents our experience of endolaryngeal laser resection in stage I and II glottic laryngeal cancer.
Objective. Evaluation of functional and oncological oucomes after endolaryngeal laser resections in patients with T1–T2 glottic laryngeal cancer.
Material and methods. The study includes 197 (100%) patients with glottic laryngeal cancer who underwent surgical treatment in the volume of endolaryngeal laser resection in the Oncology Department of Head and Neck Tumors of the National Medical Research Center for Otorhinolaryngology of the Federal Medico-Biological Agency of Russia from 2015 to 2022.
Results. Among patients with T1a tumors, relapse-free rate (RFR) was 91.07%, overall survival (OS) was 96.42%, larynx preservation (LP) was achieved in 94.64% of cases. In patients with T1b, relapse-free rate was 83.87%, overall survival – 87.09%, larynx preservation – 83.87% of cases. In T2a, RFR was 85.71%, OS – 92.85%, larynx preservation – 90.47% of cases. In T2b, RFR reached 66.66%, OS – 75%, larynx was preserved in 66.66% of cases. The indicators in T2 amounted to the following: RF – 81.48%; OS – 88.88%; LP – 85.18%. The proliferation of granulation tissue with the formation of granulations in the area of the postoperative wound was observed in 28.57% of T1a patients, in 6.45% of T1b patients, and in 33.33% of T2a cases. The cicatricial stenosis of the larynx was detected in 70.96% of T1b patients, in 11.9% of T2a patients and in 8.33% of T2b cases. In T1a patients, postoperative cicatricial stenosis was not observed.
Conclusion. Endolaryngeal laser resections of the larynx occupy a strong position in the armamentarium of methods for treating laryngeal cancer, displacing traditional organ-preserving operations performed by external access and seriously competing with conservative treatment methods. The experience of performing endolaryngeal laser resections of vocal laryngeal cancer in the Oncology Department of the National Medical Research Center for Otorhinolaryngology demonstrates the high oncological and functional effectiveness of this method.
Keywords: endolaryngeal microsurgery, larynx, complications, CO2-laser, granuloma, laryngeal stenosis, laryngeal cancer
Conflict of interest. The authors declare that they have no conflict of interest.
Funding. This study required no funding