European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 5, pp 1199–1210 | Cite as

Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO2 laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients

  • Filippo Carta
  • Fabrizio Bandino
  • Aurora Marta Olla
  • Natalia Chuchueva
  • Clara Gerosa
  • Roberto Puxeddu



 CO2 laser transoral microsurgery for glottic carcinoma, when indicated, has the well-established advantages of low morbidity and positive oncological outcomes. The present study aims to determine how patient age, and tumor site could negatively impact prognosis; other variables such as the status of the margins of resection, tobacco and alcohol intake, and the grade of differentiation of the tumors have been evaluated.


This was a retrospective analysis on 261 patients with a glottic carcinoma who underwent CO2 laser transoral microsurgery. The impact of different variables was calculated using univariate and multivariate analyses.


The study included 248 males and 13 females. The median follow-up period was 4.3 years. Five-year disease-specific survival, recurrence-free survival, local control with laser alone, overall laryngeal preservation, and overall survival rates were 99.4, 92.2, 93.8, 97.6, and 85.5%, respectively. Equivalent results were observed in young and elderly patients. Patients with positive margins after CO2 laser transoral microsurgery showed a reduced local control with laser alone. T2 patients with true subglottic spreading and patients with anterior commissure involvement of grade 3 (Rucci’s classification) experienced worse local control rates, despite free surgical margins confirmed by histology.


 CO2 laser transoral microsurgery is an effective and reproducible single-stage modality therapy for young and elderly patients with glottic carcinoma. Superficial close margins can be managed by a careful wait-and-see policy, while positive margins should undergo surgical enlargement. In our experience, undifferentiated tumors, true subglottic extension, and anterior commissure involvement of grade 3 were associated with worse outcomes.


Glottic carcinoma CO2 laser Endoscopy Transoral microsurgery Anterior commissure Subglottic extension 


Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

The research did not involve any animal models; the research involved human participants in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards; and informed consent was obtained from all individual participants included in the study.

Supplementary material

405_2018_4890_MOESM1_ESM.xlsx (253 kb)
Supplementary material 1 (XLSX 253 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Unit of Otorhinolaryngology, Department of SurgeryAzienda Ospedaliero-Universitaria di Cagliari, University of CagliariCagliariItaly
  2. 2.I. M. Sechenov First Moscow State Medical UniversityMoscowRussia
  3. 3.Unit of Pathology, Department of SurgeryAzienda Ospedaliero-Universitaria di Cagliari, University of CagliariCagliariItaly

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