Original contributionDiode laser microsurgery for treatment of Tis and T1 glottic carcinomas
Introduction
In 1915, Lynch [1] described 9 cases of endoscopic excision of early laryngeal cancer. In 1972, Strong and Jako [2] described 3 cases of laryngeal tumors treated with endoscopic approach with combined use of the carbon dioxide laser and the operating microscope. From 1980, the transoral approach with laser surgery was brought into prominence by the works of several authors. This technique allows early-stage tumors to be removed with minimal sacrifice of healthy tissue and with retention of good voice quality [3], [4], [5], [6], [7], [8]. Radiotherapy (RT) and open partial laryngectomy (OPL) achieve these objectives with more or less comparable results. Surgery is slightly superior in cure rate, but RT achieves better voice quality. Open partial laryngectomy also involves a temporary tracheotomy and a longer hospitalization.
The safety and value of the carbon dioxide and Nd:Yag lasers in endoscopic laryngeal microsurgery have been well documented for the treatment of glottic cancer. Recently, the technical evolution allowed the project of a new laser: the diode laser. Compared with the ND:Yag and carbon dioxide lasers, the diode laser is small, portable, versatile, and very simple to use. It has a stable power output, a rapid setup time, an expected long life, no installation costs, and it is virtually maintenance-free. To our knowledge, this report is the first in the literature about the laser diode surgery for the treatment of glottic cancer.
The aim of this study was to review the oncologic results in a series of 45 patients with Tis and T1 glottic cancer treated with endoscopic microsurgery by diode laser and to demonstrate the oncologic safety of diode laser surgery.
Section snippets
Materials and methods
Between January 1999 and July 2005, 61 patients affected by Tis and T1 glottic squamous cell carcinomas were endoscopically treated by diode laser at the ENT Department of the Hospital of Dolo (Venice, Italy). Data from 45 patients with a minimum follow-up of 24 months were analyzed. These cases were classified according to the 2002 AJCC-UICC TNM system and included 9 Tis (20%), 31 T1a (68.9%), and 5 T1b (11.1%) glottic carcinomas. Three patients with Tis carcinoma had distinct synchronous
Results
All patients were routinely admitted the day before surgery. The length of hospitalization ranged from 2 to 5 days with a mean of 2.2 days. No major complications were observed. The development of small granulomas was uncommon and they usually resorbed within a few weeks without any further surgery. In our series of 45 patients, we found a very low rate of glottic iatrogenic granulomas (6.6%). There were only 3 cases, all located in the posterior third of the vocal cord and resorbed within a
Discussion
Laser has been successfully used in endoscopic laryngeal surgery since 1980. The most used lasers in ENT practice are carbon dioxide, diode, and ND:Yag lasers. Diode lasers were introduced in the early 1980s with power outputs of around 100 mW, but they now have capabilities of several tens of watts of power and are widely used in industries. They are semiconductor devices that produce laser light from electrical currents passed through them and have a high electrical-to-optical efficiency:
Conclusions
Diode laser microsurgery is a safe and cost-effective procedure that offers good oncologic results and acceptable functional results in the treatment of Tis, T1a, and T1b vocal cord cancer. Local control rates and overall survival obtained in our series are comparable to those reported after RT. Diode laser is very attractive as it is small, compact, portable, efficient, relatively quiet, and very simple to use. It has a stable power output, an expected long life, no installation costs, and is
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