Carbon dioxide laser microsurgery for tongue cancer: surgical techniques and long-term results.
Thirty-seven consecutive patients with cancer of the anterior two-thirds of the tongue without clinical neck lymph nodes or distant metastasis were treated with transoral carbon dioxide (CO2) laser microsurgery. During the operation, a monopolar coagulation-suction device was applied to achieve a clear surgical field. Under a surgical microscope, we repeatedly palpated the soft tissue to identify the tumour margins, in particular the deep margin, to maintain adequate safe margins in three dimensions. We resected the tumour by en bloc procedures rather than by vaporization or debulking. Of the 28 patients in the T1 and T2 groups, 26 patients did not receive postoperative radiotherapy. The local control rate calculated by the methods of Kaplan and Meier in all 37 patients at 5 years was 93.6%. No local recurrence occurred in the T1 or T2 cases. Nine patients suffered from neck recurrence and the neck control rate at 5 years was 74.6%. Eight of these nine patients were salvaged by surgery with adjuvant radiotherapy, and six of them finally achieved disease-free status. The 5-year disease-free survival rate for our series was 88%. Our surgical techniques using CO2 laser microsurgery are effective and advantageous methods for excision of oral tongue cancer, especially stage I and II lesions.