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Laryngeal Malignancy
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Voice outcomes are comparable for T1 glottic cancers treated by either modality. Even in patients who undergo a type III cordectomy, vocal function often returns to pre-operative levels. Transoral laser microsurgery (TLM) is a same-day procedure, whilst radiotherapy involves several weeks of daily treatment. For these reasons, lesions that are limited to one vocal cord (T1a) and accessible for resection with adequate margins are commonly treated by TLM. When the tumour involves the anterior commissure or extends across two subsites (T1b or T2), voice outcome is more variable with TLM, and the choice between radiotherapy and TLM is made depending on patient factors (e.g. occupation, distance away from hospital) and tumour factors (e.g. access for resection).
Common head and neck viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
European Larynogological society classification of transoral laser cordectomy: Type I: Subepithelial cordectomyType II: Subligamental cordectomyType III: Transmuscular cordectomyType IV: Total cordectomyType V: Extended cordectomy: Va: Involving the contralateral vocal cordVb: Involving the ipsilateral arytenoidVc: Involving the laryngeal ventricleVd: Involving subglottisType VI: Cordectomy for anterior commissure carcinoma
Tumours of the Larynx
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Vinidh Paleri, Stuart Winter, Hannah Fox, Nachi Palaniappan
Although randomized data do not exist, most practising surgeons and oncologists believe that voice outcomes are comparable for T1 glottic cancers treated by either modality, and for mid-cord lesions, this should rarely be the basis for treatment selection. Even in patients who undergo resections that are type III cordectomy or more advanced, vocal function routinely returns to pre-operative levels following the initial healing period.20 In a meta-analysis of 362 patients with a mean follow-up time of 47 months, where voice outcomes measured using the Vocal Handicap Inventory, no significant difference in post-treatment VHI scores were detected between radiotherapy and surgery.21 Systematic reviews have identified no advantages in voice outcomes for patients with T1 glottic cancer treated by radiotherapy (RT) compared to transoral laser microsurgery (TLM).21–23
Application of a thyroid cartilage window technique for transoral resection of early glottic cancer involving the anterior commissure
Published in Acta Oto-Laryngologica, 2021
Qingxiang Zhang, Xiaohong Chen, Shuangba He, Lifeng Li
Based on the classification proposed by the European Laryngological Society, an expanded cordectomy involving the anterior commissure and the contralateral vocal cord (type Va), or an expanded cordectomy removing the petiole of the epiglottis, anterior portion of both vocal folds, and anterior subglottal mucosa along with the anterior commissure (type VI), is recommended to remove lesions arising in the anterior commissure or for lesions arising from one vocal cord with extension to the anterior commissure [8,9]. Although resection of thyroid cartilage for early glottic carcinoma with involvement of the anterior commissure in transoral laser microsurgery has been reported elsewhere [8,9], a comprehensive investigation with description of detailed technical nuances of a thyroid cartilage window (TCW) technique, and its associated analysis of oncologic outcomes, have not been sufficiently explored.
Variation in prognosis of early laryngeal carcinoma after different types of cordectomy with transoral laser microsurgery
Published in Acta Oto-Laryngologica, 2018
Shuo Ding, Junwei Huang, Zhigang Huang, Hongbo Xu, Wei Guo, Yang Zhang
Although the European Laryngological Society has already produced guidelines for the range of lesion excision which can be tackled by the five types of cordectomy according to local lesion type, in practical applications, it is difficult to make the correct choice. A retrospective analysis was performed by Rucci et al. [14] on 88 Tis and T1 stage patients treated with CO2 laser, and this showed that the recurrence of early laryngeal cancer is associated with type of cordectomy. There were five recurrences in patients who underwent laser surgery type I and II (14%), no recurrences with type III and IV, and 16 recurrences after type V laser surgery (66%) (p < .01) [14]. The results of our study are consistent with those of Rucci et al. [14] but there was a higher recurrence rate after type V surgery in that study compared with our study, and they did not have any clear operating recommendations with regard to the prognosis of laryngeal carcinoma at different stages.
Survival study in early stages of glottis cancer, stratified by treatment
Published in Acta Oto-Laryngologica, 2022
Yolanda Lois-Ortega, Fernando García-Curdi, Héctor Vallés-Varela, Ana Muniesa-del Campo
The patients in our study who received treatment with TLM underwent different types of cordectomy, depending on the location and extension of the tumor. Ding et al. [14] studied the prognosis of patients with SCC Tis and T1 of the glottis depending on the type of cordectomy performed and concluded that resections that include the vocal muscle reduce the possibility of recurrence, so that, in these tumors type III cordectomies or more should be performed. This agrees with the results of our study since the most performed type of cordectomy was type III, which was performed in 43.3% of patients treated with TLM, followed by total or type IV cordectomy, which was performed in 36.5% of the cases treated with TLM.