Treatment of Early Glottic Carcinoma Using Transoral Laser Microsurgery

Transoral laser microsurgery (TLM) has become a widely adopted, minimally invasive, and function-preserving surgical approach for early-stage glottic carcinoma. At our institution, TLM using the AcuPulseTM DUO CO2 laser system has been employed as the initial treatment for T1–T2 glottic cancers. This retrospective study analyzed 144 patients, including 128 initial treatment cases and 16 salvage cases, following radiation or chemoradiation therapy. In the initial treatment cohort, oncologic outcomes were favorable, with a laryngeal preservation rate of 96.8% and disease-specific survival rate of 98.4%. Among salvage cases, TLM also demonstrated utility, with a laryngeal preservation rate of 87.5% and disease-specific survival rate of 84.4%. While no significant difference was observed in the operative time, hospitalization was significantly longer in the salvage cohort than in the primary treatment cohort. Postoperative complications, such as laryngeal edema, wound infections, and partial necrosis, were more common in salvage cases than in the primary treatment cohort, requiring careful perioperative management. TLM offers several advantages over radiation therapy, including the avoidance of radiation-induced complications, shorter treatment duration, and preservation of future radiation options. Despite discontinuation of the current laser system, TLM remains a valuable surgical modality, and ongoing efforts are essential to ensure its continuation and development.