Lessons Learned from Endoscopic Treatment of Early Glottic Carcinomas: A Primer for the General Otolaryngologist

Abstract

Objectives: 1) Identify technical considerations involved in performing oncologic resection while maintaining laryngeal function. 2) Analyze on a case-by-case basis what type of treatment protocol to implement and when lesions persist or recur. Methods: A retrospective review was performed to identify all endoscopic laser resections of glottic carcinomas performed over a 4-year period. Records were reviewed to identify technical factors that led to cure vs. recurrent disease; disadvantages of extensive resection vs. adjuvant radiation; when and how often patients returned to the operating room for further resection; how to push surgical limits while maintaining good functional results; and what to expect on examination in the post-operative healing process. Results: Twelve patients were treated during the study period. Difficult exposure was not a contraindication to endoscopic resection, if the lesion did not extend to the anterior commissure. For patients with deeply invasive disease who cannot afford lengthy vocal downtime, radiation therapy is the answer. However, radiation leads to dysphagia and contralateral vocal fold injury that is avoided with surgery. Additionally, good voice can be achieved in patients undergoing intramuscular cordectomy, but it does cause longer vocal downtime compared to radiation. The key to optimal vocal results is achieving glottal closure. Patients should be counseled pre-operatively regarding the possibility of additional surgery. Conclusions: Endoscopic resection can be tailored on an individual basis based on both cancer stage and the patient’s personal needs. Patients should be counseled pre-operatively regarding the advantages and disadvantages of surgery vs. radiation, including side effects and voice results.