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.