Extent of ELS Resections Determines Vocal Quality Following Transoral Laser Microsurgery

What are the functional vocal outcomes following transoral laser microsurgery (TLM) as a treatment modality for early glottic cancer?

Background: Early laryngeal cancer of the glottis is most commonly treated with either radiation therapy or TLM. Treatment goals beyond cure are laryngeal preservation and voice outcome optimization. There is ongoing debate regarding which treatment modality best achieves these goals. A growing body of evidence suggests that TLM results in an increased laryngeal preservation rate compared with radiation therapy.

Study design: Retrospective review of 49 patients who underwent TLM for early glottic carcinoma.

Setting: Our Lady of the Lake Voice Center, Baton Rouge, La.

Synopsis: Of the 49 patients who underwent primary European Laryngological Society (ELS) resections, 26 had both pre- and post-operative Voice Handicap Index (VHI) scores. Twenty-six patients had pre-operative voice recordings and voice recordings at least one month post-operatively. ELS type I patients saw a mean VHI improvement from 38.43 to 20.43, post-operatively, and a mean perceptual score improvement from 62.63 to 76.50. ELS type II patients saw a mean perceptual score improvement from 55.50 to 70.00, post-operatively. ELS type III patients saw a mean VHI improvement from 44.33 to 27.75, post-operatively, but perceptual scores worsened slightly, from 62.90 to 57.53. ELS type I, II, and III patients combined saw a significant mean VHI improvement from 38.77 to 22.86. Patients who underwent advanced ELS resections had an increased VHI, from 33.5 to 39.0, but a marked decline in perceptual score, from 55.33 to 39.00.

Of patients who required repeat resection, mean VHI decreased from 46.0 to 24.25, but mean perceptual score rose from 61.92 to 82.08. A main limitation was that statistical analysis was not available for all groups due to low numbers.

Bottom line: Patients who undergo limited ELS resections can be assured of having a similar to improved voice after healing. Patients who undergo extended resections have poorer vocal outcomes.

Citation: Fink DS, Sinley H, Kunduk M, Schexnaildre M, Kakade A, Sutton C, McWhorter AJ. Subjective and objective voice outcomes after transoral laser microsurgery for early glottic cancer. Laryngoscope. 2016;126:405-407.