CO(2) laser endoscopic surgery is effective in the treatment of glottic carcinoma not infiltrating the cartilaginous skeleton; the results achieved are competitive with those of open conservative operations, if we take into account the possibilities afforded by salvage surgery and the rate of laryngeal preservation achieved in the study patients.

Motta G, Esposito E, Cassiano B, Motta S. T f -T 2 -T 3 glottic tumors: Jlfieen years experience with CO, lusrr. Acta Otolaryngol (Stockh) 1997; Suppl 527: 155-159. This research aims at reporting the results of endoscopic treatment of glottic carcinomas by CO, laser. The cases cited concern 516 patients with glottic Tl-T2-T3 carcinomas. The patients have been divided into 5 groups: a) Tla: 194 patients with monolateral carcinoma involving the true vocal cord who underwent simple cordectomy; b) T2a: 104 patients with monolateral cordal carcinoma involving the ventricle and the false cord; c) Tlb: 127 cases of monolateral or bilateral carcinoma involving the anterior commissure; d) these patients underwent bilateral cordectomy; T2b: 54 cases of monolateral or bilateral carcinomas involving the anterior commissure and extending to the hypoglottic or supraglottic region; in these patients a bilateral extended cordectomy was performed e) T3: 37 selected cases of monolateral or bilateral cordal carcinoma with fixed vocal cord, fixity was due to the substantial size of the tumor or to the infiltration of the paraglottic space; these patients underwent a monolateral or bilateral extended cordectomy. The following are the results at 5 years: group a: overall observed survival rate (OSR) was 79% and the adjusted survival rate (ASR) 94.5'1/0; group b: OSR 67% and ASR 77%; group c: OSR 88.4% and ASR 96.5'X; group d: OSR 82% and ASR 90%; group e: OSR 55%~ and ASR 67%. The above data are evidence of the fact that our surgical techniques offer similar or better advantages in terms of survival rate compared to the traditional procedures. It must be noted that endoscopic surgery of glottic tumors carried out by C 0 2 laser offers relevant benefits when compared with traditional surgery: i) rapidity of operation and reduced surgical trauma; ii) the possibility of avoiding tracheotomy; iii) the respect of the integrity of the cartilaginous skeleton; iu) short postoperative course and low incidence of complication; u) better functional results; vi) a shorter stay in hospital with positive psychological effects on the patients and lower social costs.

In subset A(1) subjects a positive ratio between phonatory volume and phonatory flow was maintained with an adequate phonation time. In subset A(2) subjects a reduced phonatory volume was associated with a more rapid dispersion of phonatory flow, lower duration of phonation, and frequent pauses; stomal noise and consonant hyperarticulation worsened the voice performance in this group. In group B subjects the positive ratio between phonatory volume and phonatory flow represented the prerequisite of speech without frequent pauses.

Background. The aim of the study was to evaluate the effectiveness of endoscopic CO 2 laser microsurgery in the management of supraglottic cancer.Methods. One hundred twenty-four patients (116 men and eight women; mean age, 59 years; range, 31 -81 years) with supraglottic cancer underwent CO 2 laser surgery (mean followup 5 years). The study patients were classified as follows: 45 patients, T1N0M0; 61 patients, T2N0M0; and 18 patients, T3N0M0. According to the staging, the following procedures were adopted: epiglottectomy, resection of aryepiglottic fold or false vocal cord in T1 patients (group A); resection of the false vocal cord and adjacent structures in T2 patients (group B); and supraglottic laryngectomy in T3 patients (group C). Statistical comparison of survival parameters was carried out with Wilcoxon test, considering p < .05 the minimum significance value.Results. Overall actuarial survival, adjusted actuarial survival, and no evidence of disease at 5 years were 91%, 97%, and 82% in group A; 88%, 94%, and 59% in group B; and 81%, 81%, and 51% in group C, respectively. The statistical analysis of survival parameters showed a significant difference in the comparison of T1 versus T2 and T2 versus T3 tumors (p < .01). Actuarial local control, actuarial nodal control, and actuarial distant metastasis control at 5 years were 82%, 82%, and 100% in T1 patients; 63%, 90%, and 98% in T2 patients; and 77%, 75%, and 93% in T3 patients. Laryngeal preservation rate was 88.6% in T1 patients, 85.4% in T2 patients, and 93.7% in T3 patients. Patients in groups A and B were discharged after 3 to 12 days, and patients in group C were discharged after 14 to 20 days.Conclusions. The results of this study show that endoscopic CO 2 laser surgery is highly effective in the treatment of T1 and T2 supraglottic cancer. In T3 cancer, the CO 2 laser should be implemented in those cases in which radical excision by endoscopic route is feasible. In 1978, Vaughan 1 first described the use of CO 2 laser in the treatment of early supraglottic cancer. In 1984, Motta et al illustrated the endoscopic surgical technique of supraglottic laryngectomy 2 and subsequently indicated the guidelines for supraglottic cancer resection with CO 2 laser, 3 which were validated and confirmed by other authors. 4 -7 The aim of this study was to evaluate the effectiveness of CO 2 laser microsurgery in the management of supraglottic cancer.

Occult cervical lymph node metastases may often be associated with cancers of the supraglottic larynx. The aims of this investigation were: (1) to determine the incidence of occult lymph node metastases in patients with cancer of the larynx; (2) to assess whether the presence of such metastases was related to the extent of the primary tumor (T) and its grading (G); and (3) to discuss which therapeutic approach should be followed in treating clinically occult lymph node metastases. Our investigation included 97 patients who underwent supraglottic horizontal laryngectomy and elective cervical lymph node dissection. The incidence of occult lymph node metastases in the series considered was 27%. Based on the preoperative staging of the tumor, 14% of the cases had metastatically involved lymph nodes in the T1 tumors, 21% in the T2 tumors, 35% in the T3, and 75% in the T4. In the statistical analysis, a significant difference was shown to exist when T1 + T2 and T3 + T4 (P = 0.04) were compared. In terms of grading, occult metastases were found in 16% of the G1 tumors, 27% of the G2, and 42% of the G3. The statistical analysis demonstrated a significant difference between G1 and G3. In brief, the incidence of occult metastases was higher for the less differentiated tumors and for the ones with a higher T value; the effects of both factors are combined thereby increasing the rate of occult metastases (P = 0.05).