It is now widely accepted that the oncological and voice outcomes following transoral laser microsurgery for early T1a glottic cancers are equivalent to, if not superior to, traditional radiotherapy. Voice outcomes following more extensive resections have not been as frequently investigated or reported however. This paper reviews the postoperative vocal outcomes from a cohort of patients who underwent European Laryngological Society (ELS) cordectomy types III-VI (resection into or beyond the vocalis muscle) for glottic cancers at a single institution. Eleven patients met the inclusion criteria, and outcomes were reported in terms of pre and postoperative voice handicap index (VHI) scores, maximum phonation time (MPT), and Grade and Breathiness scores. VHI was noted to worsen in the acute postoperative phase (up to four months after surgery) but had significantly improved compared to preoperative levels at long-term follow-up (greater than six months postoperatively). Grade and Breathiness also worsened in the short term but had returned to preoperative levels in the longer term. The only parameter that did not improve or return to preoperative levels was maximum phonation time. Three patients from the cohort underwent subsequent injection laryngoplasty or thyroplasty and are reported to have responded well. Although limited by small patient numbers and the retrospective nature of the study, the data from this paper certainly suggest that good long-term voice outcomes can be expected in the majority of patients who undergo extensive glottic soft-tissue resection for cancer. Such patients should be counselled preoperatively about the likelihood of an initial period of worsening of voice quality, and the potential requirement for laryngeal augmentation procedures in a small minority.
Voice outcomes following extended laser resections for laryngeal cancer
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