Surgery of T1/2 N0 M0 glottic cancer results in a better laryngeal preservation time compared to radiotherapy in a large German patient cohort.

Objective: This retrospective study examined overall survival (OS), recurrence free survival (RFS), and laryngeal preservation time in a large cohort of 663 patients with T1/2 N0 M0 glottic cancer after transoral laser or open surgery vs radiotherapy.

Methods: A total of 595 surgically treated patients and 68 individuals after definitive radio(chemo)therapy (R (C)-T) were studied. Patient characteristics including sociological, surgical, and pathological data, OS and RFS as well as laryngeal preservation time were recorded and compared between various groups/cohorts.

Results: There were no significant differences in OS and RFS between surgically treated and conservatively treated patients. However, laryngeal preservation time was significantly higher in surgically treated patients (p < 0.001) (mean: 138.3 ± 2.2 months, versus 102.8 ± 7.6 months) than those under conservative treatment. The surgical treatment method (transoral vs. open partial resection) did not influence OS or RFS. Additionally, the rate of transoral vs. open surgery did not change over a decade. T2-stage patients showed significantly lower RFS than T1-stage patients. Initial R status significantly influenced OS and tumor recurrence.

Conclusion: The findings of this study exhibited a significantly longer laryngeal preservation time in patients with T1/2 N0 M0 glottic cancer treated surgically than in those treated with radiotherapy. No significant differences in OS or RFS were observed between open partial laryngectomy and transoral laser surgery. The R status had a significant impact on OS and RFS, with OS being significantly associated with an R0 status, regardless of T status or the surgical approach (open versus transoral). Laryngeal preservation surgery is recommended as a central therapeutic strategy for T1/2 N0 M0 glottic cancer because it has a higher laryngeal preservation rate than the conservative treatment. Given the high recurrence rate (18.5%) and the necessity of laryngo- (pharyng) ectomy in a substantial proportion of recurrent patients (7.7%), the choice of initial therapeutic approach is critical.