Narrow-Band Imaging in Transoral Laser Surgery for Early Glottic Cancer: A Randomized Controlled Trial

Objective: Assessing whether the additional use of narrow-band imaging (NBI) in transoral laser surgery (TOLS) for early laryngeal cancer improves clinical outcomes. Study Design: Randomized controlled trial, performed between September 2015 and November 2022. Setting: A tertiary referral hospital in The Netherlands. Methods: TOLS was carried out in 113 patients. The procedure was performed with white light imaging (WLI, n = 56) alone, or combined with NBI (n = 57). Patients received frequent follow-up laryngoscopy. Resection margin status, recurrence rate, and recurrence-free survival at 12 months, 18 months, and after study termination (maximum 86 months) were analyzed. Results: Thirty-one cases in the WLI group had a positive resection margin, versus 16 in the NBI group (p =.002). After 12 months, the recurrence-free survival was 92%: 87% for WLI versus 96% for NBI, p =.07. The recurrence rate was 7/56 (13%) for WLI, versus 2/57 (4%) for NBI, p =.09. After 18 months, the recurrence-free survival was 84% for WLI versus 96% for NBI, p =.02. The recurrence rate was 9/56 (16%) for WLI, versus 2/57 (4%) for NBI, p =.02. After study termination, the recurrence-free survival was 71% for WLI versus 83% for the NBI group (p =.08). The recurrence rate was 16/56 for WLI, versus 10/57 for NBI (p =.16). Conclusion: The additional use of NBI during TOLS significantly decreased the number of positive resection margins. Although not statistically significant at all time points, patients treated with NBI-supported TOLS showed a lower recurrence rate and better recurrence-free survival. Further studies in larger patient groups are needed to confirm these results.