Participants
The study group consisted of adult patients with pathologically proven T1/N0/M0 glottis squamous carcinoma who were treated and followed at the Ear-Nose-Throat (ENT) Department of one hospital from October 2008 to October 2014.All the surgeries were performed by 3 specialists, each with more than 10 years of surgical experience. Patients were excluded if they had a second primary tumor, were younger than 18 years old, received primary radiotherapy, had a repeated cancer, or if data were missing or insufficient for analysis.
Tumors were staged according to the American Joint Committee on Cancer (AJCC) TNM cancer staging system (sixth edition, 2002) [10]. Involvement of the anterior commissure was defined as visible spread of the tumor to the anterior-most extent of a single membranous vocal fold or continuously from one vocal fold to the other. For each patient, the surgeons explained the detailed benefits and disadvantages of each kind of therapy, including the effect on voice quality. In our institution, RFA is always the primary surgical option. But, we choose open surgery if the patient’s larynx cannot be sufficiently exposed, if there is deep infiltration of the tumor into the anterior commissure, or if there is a large stage T1b tumor involving the anterior commissure. The surgeon’s determinations of deep infiltration and tumor stage were based on evaluation of preoperative electronic laryngoscopy and computed tomography (CT) images.