Application of a thyroid cartilage window technique for transoral resection of early glottic cancer involving the anterior commissure

Abstract

Background

Management of early stage glottic carcinoma involving the anterior commissure is challenging.

Aims/objectives

This study aimed to evaluate the efficacy of a thyroid cartilage window (TCW) technique for transoral laser resection of early glottic cancer with involvement of the anterior commissure.

Material and methods

Twenty-one patient who underwent a TCW technique for transoral resection early glottic carcinoma involving the anterior commissure, were retrospectively analyzed. The technical nuances, organ preservation rate and voice outcomes, local and regional recurrence, and perioperative comorbidities, were assessed.

Results

All 21 patients underwent a TCW technique for resection, both the organ preservation rate and negative margin achieved 100%. The local control rate achieved 100%, and the 5 years recurrence free survival was 90.5%. For two patients with subglottic involvement (9.5%), regional recurrence with confirmation of a positive pre-laryngeal lymph node was observed. Postoperative granuloma was detected in all 21 patients, 13 of whom spontaneously disappeared (61.9%); whereas the remaining 8 patients (38.1%) demonstrated a consistent presence of granuloma more than 12 weeks, and they accepted surgical extirpation of granuloma under surface anesthesia. The laryngeal web developed in all 21 patients, while no dyspnea and local recurrence were present. By comparison with preoperative baseline, postoperative self-assessment voice demonstrated a significant improvement (p = .01), while objective voice indices were not significantly altered (p > .05).

Conclusions and significance

TCW technique is a valuable means for transoral resection of early glottic laryngeal cancer involving the anterior commissure, with acceptable voice quality and seemingly low comorbidities.

Chinese abstract

背景：早期累及前连合声门癌治疗是具有挑战性的。

目的：本研究旨在评估甲状腺软骨窗（TCW）技术用于经口激光切除早期累及前连合声门癌的疗效。

材料和方法：回顾性分析了二十一名接受用TCW技术经口切除术的早期累及前连合声门癌患者。评估了技术细微差别、器官保留率和声音结果、局部和区域复发以及围手术期合并症。

结果：所有21例患者均接受了TCW切除术, 器官保留率和负边缘均达到了100％。局部控制率达100％, 5年无复发生存率为90.5％。对于2位声门下受累患者（9.5％）, 观察到局部复发并确认喉前淋巴结阳性。在所有21例患者中检测到术后肉芽肿, 其中13例自发消失（61.9％）；而其余的8患者（38.1％）的肉芽肿持续存在超过12周, 在表面麻醉下接受肉芽肿的手术摘除。在所有21例患者均发生喉网, 但未出现呼吸困难和局部复发。与术前基线比较, 术后自测声音表现出显著改善（p¼.01）, 而客观语音指数没有显著改变（P> 0.05）。

结论与意义：TCW技术是经口激光切除早期累及前连合声门癌的一种有效手段, 结果为较好的声音质量和较低的合并症发生率。

Keywords:

• Early glottic carcinoma
• transoral laser microsurgery
• anterior commissure
• thyroid cartilage
• window technique

Disclosure statement

No potential conflict of interest was reported by the author(s).