Conservative laser microsurgery for T1 glottic carcinoma.

Objective: The purpose of the study was to assess whether partial cordectomy or complete cordectomy with narrow free margins is a safe oncological procedure for T1 glottic carcinoma. We also studied surgical margins and the involvement of anterior commissure. Methods: Thirty-one T1 glottic carcinomas underwent endoscopic CO2 laser excision of the lesion based on the depth of infiltration by the tumor with 1–2 mm free margins. If detecting free margins was not macroscopically possible, additional biopsies along all the uncertain margins of the excision’s residual area were taken. After excision, the specimen was mounted on a plastic support, flattened and then held in place with fine needles. It was then oriented and mapped. The pathologist measured the lesion’s point of maximum infiltration and its distance from the free margins. Results: Local and ultimate control at 36 months was 95% and 100%, respectively.We performed 29 partial and two complete cordectomies. Complete resection of the lesion was obtained in 90.4% of the cases. Re-resection was necessary in 9.6% of the cases due to positive margins. The anterior commissure was affected in 38.7% of the cases, and was the site of maximum infiltration in 9.6% of the cases. The mean maximum infiltration was 0.93 mm in the anterior commissure, 2.18 mm in the anterior 1/3rd of the vocal cord, 1.71 mm in the middle 1/3rd of the vocal cord and 1.5 mm in the posterior 1/3rd of the vocal cord. In 83.9% of the cases ( p < 0.01), the anterior 1/3rd of the vocal cord was the section most frequently involved. In 19 patients (61.3%) ( p < 0.01), the anterior 1/3rd of the vocal cord was also the area with the highest incidence of maximum infiltration by the tumor. Conclusion: We concluded that 1) T1 glottic carcinoma can be conservatively managed with CO2 laser. 2) Involvement of the anterior commissure is not an absolute contraindication to endoscopic CO2 laser excision.