Flexible Endoscopic Approach to Glottic Carcinoma: Five-Year Oncological Outcomes.

Objective: The objective of this study was to demonstrate the long-term oncologic efficacy of flexible endoscopic laryngeal surgery (FELS) in treating T1-T2 glottic carcinoma.

Methods: From 134 patients who underwent FELS, 90 patients (males-82, females-8), aged 18-83 (mean-56.9 ± 10.7) with early glottic carcinoma (T1a-27, T1b-24, and T2-39) were included in the study. Fifty-seven patients (63.3%) underwent FELS under local anesthesia with spontaneous ventilation, the rest of the patients were operated on under general anesthesia with superimposed high-frequency jet ventilation (SHFJV). Tumor ablation by Nd:YAG laser was performed in all the cases, preceded by diathermy snare excision in one-third of cases. In 20 of the T2 cases, adjuvant radiotherapy (RT) was performed.

Results: Five-year overall survival and ultimate disease control, including salvage treatment, was obtained in 82/90 patients (91.1%), cure with larynx preservation-in 88.9% of cases, disease-free survival-in 83.3% of cases, and ultimate local control with FELS alone-in 86.7% of cases. The best 5-year oncological results were obtained in the T1a group of treated patients, all the patients being alive and free of disease with the preserved larynx due to FELS alone. There was no evidence of better oncological results by FELS under general anesthesia with SHFJV over FELS under local anesthesia with spontaneous ventilation. Anterior commissure (AC) involvement worsened the treatment results. Adjuvant RT did not demonstrate an improvement of oncological results in the T2 group of patients.

Conclusions: FELS demonstrates oncological outcomes that are comparable to RT and transoral laser microsurgery and can be considered an oncologically efficient method of treatment of T1-T2 glottic carcinoma. Awake FELS is not inferior to FELS under general anesthesia with SHFJV concerning oncological efficacy. More studies on a bigger clinical material are necessary for definitive conclusions concerning the impact of AC affection and adjuvant RT on the oncological results.