Longitudinal Voice Outcomes Following Advanced CO2 Laser Cordectomy for Glottic Cancer

      Summary

      Objective

      CO2 laser cordectomy for glottic carcinoma offers excellent oncologic control on a per stage basis as compared with primary radiotherapy. We aim to further investigate the fluctuations of postoperative vocal outcomes following extended laser cordectomy for glottic cancer.

      Design

      Single center retrospective cohort study.

      Methods

      Eleven patients with glottic squamous cell carcinoma (SCC) who received CO2 laser cordectomy European Laryngological Society type III-IV with complete datasets at preoperative, immediate postoperative (within 4 months), and delayed (greater than 6 months) time points were included.

      Results

      All patients (n = 11) received cordectomy as their primary treatment. Tumor stage was divided evenly between T1 and T2. One patient was referred for post-cordectomy thyroplasty. Mean Voice Handicap Index (VHI) scores increased in the immediate postoperative period (43.3–46.2) but did not reach significance (P > 0.05). Delayed postoperative VHI (23.3) demonstrated substantial improvement from both pre- and immediate postoperative levels (P = 0.047). Objective voice rating significantly declined initially (P = 0.03; Grade, P = 0.01; Breathiness) and recovered to similar preoperative levels. Maximum phonation time (MPT) showed substantial decreases at the initial postoperative period (P = 0.007). Although significant improvement was made at the delayed postoperative point (P = 0.009), MPT remained below the preoperative level (P = 0.028). No significant changes were seen in phonatory subglottic pressures.

      Conclusions

      Patients undergoing extended CO2 laser cordectomy for glottic cancers can experience initial decline in voice quality; however, vocal function routinely returns to preoperative levels following the initial healing period. A small percentage of extended cordectomy patients may require further vocal interventions.

      Key Words

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Karatzanis A.D.
        • Psychogios G.
        • Zenk J.
        • Waldfahrer F.
        • Hornung J.
        • Velegrakis G.A.
        • Iro H.
        Comparison among different available surgical approaches in T1 glottic cancer.
        Laryngoscope. 2009; 119: 1704-1708
        • Hartl D.M.
        • de Monès E.
        • Hans S.
        • Janot F.
        • Brasnu D.
        Treatment of early-stage glottic cancer by transoral laser resection.
        Ann Otol Rhinol Laryngol. 2007; 116: 832-836
        • Wedman J.
        • Heimdal J.H.
        • Elstad I.
        • Olofsson J.
        Voice results in patients with T1a glottic cancer treated by radiotherapy or endoscopic measures.
        Eur Arch Otorhinolaryngol. 2002; 259: 547-550
        • Cohen S.M.
        • Garrett C.G.
        • Dupont W.D.
        • Ossoff R.H.
        • Courey M.S.
        Voice-related quality of life in T1 glottic cancer: irradiation versus endoscopic excision.
        Ann Otol Rhinol Laryngol. 2006; 115: 581-586
        • Peeters A.J.
        • van Gogh C.D.
        • Goor K.M.
        • Verdonck-de Leeuw I.M.
        • Langendijk J.A.
        • Mahieu H.F.
        Health status and voice outcome after treatment for T1a glottic carcinoma.
        Eur Arch Otorhinolaryngol. 2004; 261: 534-540
        • Sjögren E.V.
        • van Rossum M.A.
        • Langeveld T.P.
        • et al.
        Voice outcome in T1a midcord glottic carcinoma: laser surgery vs radiotherapy.
        Arch Otolaryngol Head Neck Surg. 2008; 134: 965-972
        • Remacle M.
        • Eckel H.E.
        • Antonelli A.
        • et al.
        Endoscopic cordectomy. A proposal for a classification by the Working Committee, European Laryngological Society.
        Eur Arch Otorhinolaryngol. 2000; 257: 227-231
        • Remacle M.
        • Van Haverbeke C.
        • Eckel H.
        • et al.
        Proposal for revision of the European Laryngological Society classification of endoscopic cordectomies.
        Eur Arch Otorhinolaryngol. 2007; 264: 499-504
        • Hirano M.
        • Koike Y.
        • Von Leden H.
        Maximum phonation time and air usage during phonation. Clinical study.
        Folia Phoniatr (Basel). 1968; 20: 185-201
        • Speyer R.
        • Bogaardt H.C.
        • Passos V.L.
        • et al.
        Maximum phonation time: variability and reliability.
        J Voice. 2010; 24: 281-284
        • Piazza C.
        • Bolzoni Villaret A.
        • Redaelli De Zinis L.O.
        • Cattaneo A.
        • Cocco D.
        • Peretti G.
        Phonosurgery after endoscopic cordectomies. II. Delayed medialization techniques for major glottic incompetence after total and extended resections.
        Eur Arch Otorhinolaryngol. 2007; 264: 1185-1190
        • Higgins K.M.
        • Shah M.D.
        • Ogaick M.J.
        • Enepekides D.
        Treatment of early-stage glottic cancer: meta-analysis comparison of laser excision versus radiotherapy.
        J Otolaryngol Head Neck Surg. 2009; 38: 603-612
        • Higgins K.M.
        What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility?.
        Laryngoscope. 2011; 121: 116-134