INTRODUCTION
Laryngeal carcinoma accounts for 30 to 50% of all head and neck cancers
worldwide. In China, the mortality rate from laryngeal cancer is 14.5%
[1,2] and 56–75 % of these patients are diagnosed with early-stage
(T1/T2) cancer, which mostly arises from the glottis [3]. Most
patients diagnosed with early-stage laryngeal cancer present with a main
symptom of hoarseness. The treatment modalities used for these patients
can affect oncological and vocal outcome.
The therapeutic modalities used for early glottis carcinomas (Tis, T1,
and selected T2 cases) include open surgery, endoscopic resection, and
radiotherapy, or a combination of these [4]. The optimal treatment
to be used for early-stage glottis cancer is still disputed, and depends
on oncological and functional outcomes, cost, duration of
hospitalization, doctor-patient communication, religious beliefs, and
other factors [5,6]. The anterior commissure of the larynx is a weak
point that easily permits invasion of tumors into the thyroid cartilage
because of the missing perichondrium/periosteum at the insertion of the
Broyles’ ligament [7]. However, the anterior commissure is a
clinical rather than an anatomical term, and the impact of anterior
commissure involvement in laryngeal carcinoma has been controversial for
many years. Even in patients with early-stage glottis cancer, anterior
commissure involvement was considered a poor prognostic factor in some
studies but not in others [8].
In the present study, we used radiofrequency ablation (RFA) with
endoscopic surgery, which has the same surgical principle and margin as
the CO2 laser microsurgery. However, RFA has the benefit
that it works at a temperature of 60°C and therefore protects against
peripheral soft tissue injury [9].
Very few previous retrospective case-series compared RFA with open
surgery for the treatment of stage T1 glottis squamous cell cancer. The
present retrospective single-center study evaluated the oncological and
vocal outcomes of patients who received RFA or open surgery for stage T1
glottis squamous cell cancer, with a special focus on patients with
involvement of the anterior commissure.