Laryngeal Cancer (Clinical Case-Based Approaches) || 4 T1b Glottic Cancer Treated with Transoral Laser Surgery

摘要： T1b squamous cell carcinoma (SCC) of the glot- tis can be treated with radiotherapy or transoral laser surgery. Radiotherapy is usually advocated since voice results are considered better compared to transoral laser surgery; nevertheless, the tran- soral approach is also frequently performed for T1b at the request of the patients. In such cases, special care is needed to avoid unexpected scar. This chapter reports the typical case of a T1b SCC of the glottis with involvement of the anterior commissure observed in a 69-year-old male with a clinical history of daily cigarette smoking for 20 years, and progressive hoarseness lasting for 1 year, who underwent en bloc bilateral subligamen- tal type II cordectomy. The patient, after 3 years of follow-up, is free of cancer. The endoscopic treat- ment in the form of type II cordectomy was chosen for the following reasons: (1) the surgical strat- egy has the advantages of a histologically proven resection without residual cancer and, in case of recurrence a further surgical treatment (includ- ing transoral surgery) and also radiotherapy are still available; (2) early cancer of the glottis is associated with a low incidence of occult metas- tasis and there is no indication for the neck dis- section in cN0 patients; (3) the transoral approach allows for treatment of the cancer with minimal complications, low trauma to healthy tissue, and without the need for tracheostomy and/or nasoga- stic feeding tube; (4) the patient requested to be treated quickly in one stage. In our opinion, tran- soral CO2 laser microsurgery is an important treat- ment option in T1b cancer of glottis.