Zhang Qingxiang, Chen Xiaohong, He Shuangba, Li Lifeng
Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Otolaryngology-Head & Neck Surgery, Nanjing Tongren Hospital, Nanjing, China.
Acta Otolaryngol. 2021 Feb;141(2):197-202. doi: 10.1080/00016489.2020.1832254. Epub 2020 Oct 29.
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.
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.
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 ( = .01), while objective voice indices were not significantly altered ( > .05).
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.
早期累及前联合的声门癌的治疗具有挑战性。
本研究旨在评估甲状腺软骨开窗(TCW)技术经口激光切除累及前联合的早期声门癌的疗效。
回顾性分析21例接受TCW技术经口切除累及前联合的早期声门癌患者。评估技术细节、器官保留率和嗓音结果、局部和区域复发情况以及围手术期合并症。
所有21例患者均接受了TCW技术切除,器官保留率和切缘阴性率均达到100%。局部控制率达到100%,5年无复发生存率为90.5%。2例有声门下受累(9.�%)的患者观察到区域复发,证实喉前淋巴结阳性。所有21例患者均检测到术后肉芽肿,其中13例(61.9%)自发消失;其余8例(38.1%)肉芽肿持续存在超过12周,他们接受了表面麻醉下的肉芽肿手术切除。所有21例患者均出现喉蹼,无呼吸困难和局部复发。与术前基线相比,术后自我评估嗓音有显著改善(P = 0.01),而客观嗓音指标无显著改变(P > 0.05)。
TCW技术是经口切除累及前联合的早期声门喉癌的一种有价值的方法,嗓音质量可接受,合并症似乎较少。