Curative Effect Analysis Of CO₂ Laser Surgery For Early Glottic Cancer Involving The Anterior Commissure

Objective Laryngeal cancer is a common type of head and neck malignancies,and its incidence is second only to nasopharyngeal cancer.According to whether the tumor is derived from the larynx,it can be divided into primary laryngeal cancer and secondary laryngeal cancer.Primary laryngeal cance is more common than secondary laryngeal cancer.And according to the location of the tumor,it can be divided into the supraglottic cancer,the glottic cancer and subglottic cancer.Early glottic cancer is derived from the the vocal cords,which TNM stage is Tis-T1 and T2.In the past,the treament of laryngeal cancer mainly includes open operation,radiotherapy and chemotherapy.However,recently,with the tumor completely resected as a premise,it's known and accepted that CO2 laser therapy has the following advantages:less trauma and hemorrhage;more cost-effective;lower incidence of the postoperative complications;retaining the function of voice and the quality of life to the maximum extent.Though CO2 laser therapy has been used widely in the early glottic cancer with anterior commissure invasion,it is also quite controversial because of its high recurrence rate.Voice quality is an important factor to evaluate the curative effect.And because of the favorable prognosis of these tumors,voice quality for these patients is the major factor in selecting the type of treatment.This study aimed to analyze the efficacy and recurrence rate of CO₂ laser surgery in early glottic cancer involving the anterior commissure,and the voice quality was also taken into consideration.Method 60 Patients with early glottic cancer with anterior commissure invasion were treated in Anhui Provincial Hospital from January,2002 to December,2015.All the patients should satisfied the following inclusion criteria:1.using electronic laryngoscope,cervical CT and physical examination to exclude patients with local or distant metastasi;2.the histopathology were proved to be squamous cell carcinoma;3.TNM stage were Tis-T2.According to the TNM staging criteria proposed by American Joint Committee on Cancer?AJCC?,there were 21 of T1a,25 of T1b and14 of T2.All patients use the G of GRBAS for voice assessment at least 6 months after surgery.Patients were divided into four levels?0-3?:G0 is normal voice,G1 light dysplasia,G2 is moderately dysplasia and G3 is fatal exception.0-2 levels were considered to be good voice.Result These patients were followed-up for 12-72 months,with a median follwo-up time of 48 months.1.The total local recurrent rate was 16.7%?10/60?and the recurrent ratio of T_1a,T_1b,T₂ were 9.5%?2/21?,16.0%?4/25?,28.5%?4/14?respectively,with significant difference between them?p<0.05?.2.The recurrent ratio of patients underwent type II,III,IV and V cordectomy were 0.0%?0/3?,9.0%?2/22?,15.0%?3/20?and 33.3%?5/15?.There is also statistical significance among the four operation types?p<0.05?.3.According to the operation date,the recurrence of the front 30 patients was 23.3%?7/30?,which was significantly higher than that in the late 30 patients?10.0%,3/30??p<0.05?.4.There were 59 patients who accepted the voice assessment?one patient was excluded because of recurrence within 6months?.The cases of G0-G2 were54?91.5%,54/59?and G3 were 5?8.5%,5/59?.Conclusion According to our research,CO2 laser surgery is an effective treatment for patients with early glottic cancer with anterior commissure invasion.Among the patients,T_1a's curative effect was good and T_1b is CO2 laser surgery's indication,however,it needs a careful choice for T2.Also,we found that different TNM stages,different operation types and whether the operation was taken recently all have statistical significance.The voice quality were good for most patients after operation.