2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Reprinted by permission of Laryngoscope. 2016; 126(9):2051-2056.

The Laryngoscope V C 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Voice Outcome According to Surgical Extent of Transoral Laser Microsurgery for T1 Glottic Carcinoma

Hyoung Shin Lee, MD; Ji Su Kim, MS; Sung Won Kim, MD; Woong Jae Noh, MD; Young Joon Kim, MD; Dasol Oh; Jong Chul Hong, MD; Kang Dae Lee, MD

Objectives/Hypothesis: To evaluate the outcomes of transoral laser microsurgery (TLM) for T1 glottic carcinoma using longitudinal voice analysis. Study Design: Retrospective analysis of medical records. Methods: We conducted a retrospective review of 57 patients (50 T1a, seven T1b) who underwent TLM for T1 glottic carcinoma, and longitudinal voice analysis was performed before surgery, during the early postoperative period (within 3 months), and during the late postoperative period (more than 6 months). Acoustic, perceptual (Grade, Roughness, Breathi- ness, Asthenia, Strain scale), and subjective voice analysis using the Voice Handicap Index (VHI) was conducted. Results: Voice quality deteriorated in the early postoperative period in terms of several parameters. However, no signifi- cant differences in voice quality were observed in the late postoperative period, whereas Grade (from 1.85 6 0.83 to 1.50 6 0.90) and Roughness (from 1.74 6 0.73 to 1.48 6 0.87) had improved significantly. Patients who underwent lesser-extent cordectomy (type I, II) showed improvement in VHI-Physical (from 12.93 6 11.10 to 6.07 6 8.69) and Grade (from 1.60 6 0.68 to 0.98 6 0.83), whereas improvement was not identified in those who underwent larger-extent cordectomy (type III, IV, V). Improvement in Grade (from 1.70 6 0.80 to 1.23 6 0.91) and Roughness (from 1.77 6 0.73 to 1.25 6 0.76) was iden- tified in patients who had unilateral tumor without involvement of anterior commissure. However, those with involvement of the anterior commissure or bilateral vocal cord showed a tendency toward deterioration in voice quality. Conclusions: Voice quality of patients following TLM for T1 glottic carcinoma may improve significantly over time in cases with lesser-extent types of cordectomy or unilateral tumor without involvement of the anterior commissure. Key Words: Laryngeal carcinoma, glottis, squamous cell carcinoma, carbon dioxide laser, voice. Level of Evidence: 4 Laryngoscope , 126:2051–2056, 2016

ter vocal outcomes 8–11 compared to those of TLM. How- ever, studies presenting worse vocal outcomes after TLM are mostly based on a small sample size with a heteroge- neous tumor extent and patient group. 8–10 A recent study 12 of 95 patients showed that voice quality was bet- ter after radiation therapy than it was after TLM for T1a glottic carcinoma, but outcomes were only evaluated using subjective patient evaluation. Aaltonen et al. 11 reported that patients treated with TLM had more breathy voice with wider glottic gap compared to those treated with radiation therapy. However, the extent of laser resection in each patient of the TLM group was not described in detail. Several other studies 13–15 have reported that voice outcome was comparable between TLM and radiation therapy in selected patients with T1 glottic carcinoma. In our previous study 1 we demonstrated the excel- lence of TLM for early glottic carcinoma based on the oncologic outcome. According to our clinical experience, TLM for early-stage glottic carcinoma did not necessarily lead to deterioration of voice quality and even showed improvement in some selected cases. For a head and neck surgeon who has to explain the surgical morbidity of TLM to the patient, the predicted change of voice in each individual at each time point before and after the surgery may be an area of concern. In addition, pre- dicted short-term and long-term voice quality after TLM

INTRODUCTION Treatment modalities of early-stage glottic carci- noma include transoral laser microsurgery (TLM), exter- nal transcervical surgery, and external radiation therapy. Various studies have demonstrated the onco- logic safety and advantages of TLM, 1–3 and it is consid- ered the surgical treatment of choice for early-stage glottic carcinoma in many centers. However, there is still controversy over TLM versus radiation therapy as the optimal treatment method. 4,5 Some authors consider radiation therapy to be the treatment of choice in patients with early-stage glottic carcinoma based on studies presenting similar oncologic outcomes 6,7 and bet- From the Department of Otolaryngology–Head and Neck Surgery ( H . S . L ., J . S . K ., S . W . K ., W . J . N ., Y . J . K ., K . D . L .), Kosin University College of Medi- cine, Busan, Korea; Innovative Biomedical Technology Research Center ( H . S . L ., S . W . K .), College of Medicine, Kosin University, Busan, Korea; Kosin University College of Medicine ( D . O .), Busan, Korea; Department of Otolaryngology–Head and Neck Surgery ( J . C . H .), Dong-A University College of Medicine, Busan, Korea. Editor’s Note: This Manuscript was accepted for publication October 27, 2015. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Kang Dae Lee, MD, PhD, Department of Otolaryngology, Kosin University Gospel Hospital, Am-Nam Dong 34, Seo-Gu, Busan, 602-702, South Korea. E-mail: kdlee59@gmail.com

DOI: 10.1002/lary.25789

Laryngoscope 126: September 2016

Lee et al.: Voice After Transoral Laser Microsurgery

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