Except for the report by Steiner and Ambrosch,7 our analysis is the first publication worldwide of the long-term results of laser surgery for supraglottic cancer based on a major case load. The literature is predominantly devoted to laser surgery of glottic cancer; few reports have been published on laser treatment of supraglottic cancer. In the history of ear, nose, and throat laser surgery, the treatment of supraglottic cancer is a comparatively recent development. In 1978, Vaughan3 first pointed out the possibility of using this laser for the resection of early supraglottic cancer. In 1983, Davis et al2 described the first experience with the CO2 laser in 10 patients with supraglottic cancer, but laser resection was applied in 6 patients only for staging purposes. Similarly, in a subsequent report18 comprising 24 patients, the laser was used primarily for staging before definitive radiotherapy. In 1990, Zeitels et al6 explicitly described the technique of laser epiglottectomy and reported their experience with 51 patients. However, in this group, only 27 patients had malignant tumors of the supraglottis, and the laser procedure was applied exclusively for diagnostic purposes, serving for excisional biopsy in 20 patients. In 7 patients with T1 or T2 tumors, excisional biopsy was able to achieve R0 resection. The authors considered the presence of T1 and T2 tumors to be an indication for curative laser resection of supraglottic cancer; in the case of invasion of the preepiglottic space (according to American Joint Committee on Cancer classification T3), they recognized the limitations of this method and preferred an external approach. In this study, no long-term results were given. By 1994, Zeitels et al5 could look back on 45 patients treated with laser surgery, 36 of whom had supraglottic cancer (T1-T3 and N0). In 22 patients (T1, 16 patients; T2, 6 patients; 19 patients had supraglottic localization of the primary tumor), a local en bloc resection was carried out without further surgical treatment or radiotherapy. No local recurrences were observed in this group. Twenty-three patients with more extensive tumors (T2-T3; 18 patients had supraglottic tumor localization) who, according to the authors, had not come into consideration for a classic transcervical supraglottic partial resection were subjected to excisional biopsy of the primary tumor with the CO2 laser, followed by radiotherapy with the inclusion of the primary tumor and cervical lymph drainage. In 16 of these 23 patients, R0 resection was achieved; in this group, there was no local recurrence. Five of 7 patients with R1 resection had a local or regional recurrence during follow-up. Therefore, as the authors concede, this patient group represents a highly selective sample of small, respectively "early," supraglottic cancers without formation of cervical metastases and thus substantially differs from our case load exhibiting an N+ condition in 36% of patients and UICC stage IV in 35% of patients. Rudert and Werner4 described their experience with CO2 laser resection in 30 patients with supraglottic cancers; a further 17 patients had received palliative treatment in the form of tumor debulking. Although Zeitels et al5 advocated transcervical tumor resection in the case of tumor invasion of the preepiglottic space, Rudert and Werner4 did not uphold this general demand but rather refrained from transoral laser surgery if the tongue base was infiltrated. Fifteen of 30 tumors treated by Rudert and Werner4 using laser surgery could be assigned to categories T3 and T4. Eleven patients were subjected to neck dissections, and 21 patients received postoperative irradiation. In this context, the authors emphasized the need to include the neck in therapeutic considerations. During mean follow-up of 27 months, 4 of 30 patients died of the tumor. Beyond this, no survival analysis was carried out. Köllisch et al19 compared functional results between transoral laser surgery and supraglottic partial resection with an external approach. Their study yielded the result that transoral laser surgery was superior to transcervical supraglottic partial resection in terms of the time required to restore the patient's swallowing capacity, in terms of tracheotomy rate, and in terms of incidence of aspiration pneumonias. In our case load, only 13% of patients were tracheotomized; and in 4%, the tracheostoma could be resealed after appropriate deglutition training. Twelve patients, however, had to remain tracheotomized because of postoperative aspiration problems; of these, 11 had pT4 cancer with extensive resections in the area of the tongue base. No patient had to be laryngectomized because of persisting aspiration, which—according to Suárez et al20—was necessary in 10% of their patients after transcervical supraglottic partial resection. In a further 24% of their patients, the tracheal cannula could not be removed.