Comparison of Efficacy of Carbon Dioxide (CO2) Laser with Cutting Diathermy in Surgical Excision of Early Carcinoma Tongue

Objective: To compare the efficacy of carbon dioxide (CO2) laser with cutting diathermy as a cutting device in surgical excision of early carcinoma tongue. Study Design: Experimental study. Place and Duration of Study: Combined Military Hospital (CMH), Rawalpindi and CMH, Lahore, from July 2008 to July 2011 Methodology: Twenty two biopsy proven cases of T-1 and early T-2 squamous cell carcinoma of tongue were divided in two equal groups of 11 each labeled as A and B. Tumor was excised by CO2 laser in group A while cutting diathermy was done in group B. For both groups tumor excision time, per-operative blood loss, postoperative oral swelling and pain was recorded. Excision time of tumor was assessed in minutes and amount of blood loss in milliliters till complete hemostasis after removal of primary tumor. Postoperatively patients were assessed on 12 hourly basis for 48 hours for pain. Pain was analyzed on visual analogue score 1 - 10. Oral swelling was assessed once after 24 hours and labeled as mild, moderate and severe. Independent sample t-test was applied for analysis of excision time, postoperative pain and per-operative blood loss for both groups. Postoperative swelling was analyzed using Fisher's exact test. P-value of < 0.05 was considered significant. Results: The mean age at diagnosis in group A was 49.36 +/- 5.27 years, while in group B patients had mean age of 50.73 +/- 8.13 years. In group A, 4/11 (36.3%) patients were having tumor stage T-1 while 7/11 (63.6%) had T-2 stage tumor. In group B, 5/11(45.4%) were having T-1 and 6/11(54.5%) were having stage T-2 tumor. Excision time was significantly shorter for group B (p=0.003), but group A had less postoperative pain (p=0.001), less per-operative blood loss (p=0.001) and less postoperative oral swelling (p=0.021). Conclusion: Early carcinoma tongue is better removed by laser than electrocautery in terms of postoperative morbidity, per-operative blood loss, postoperative pain and oral swelling.