Endoscopic vertical partial laryngectomy

Area of Science:

• Otolaryngology
• Oncology
• Surgical Oncology

Background:

• Glottic squamous cell carcinoma presents treatment challenges, particularly for T1b and T2 stages.
• Endoscopic vertical partial laryngectomy (EVPL) offers a less invasive alternative to traditional cordectomy.
• Vocal cord mobility status and anterior commissure involvement are critical prognostic factors.

Purpose of the Study:

• To differentiate EVPL from microlaryngoscopy with cordectomy.
• To assess EVPL efficacy for T1b and T2 glottic squamous cell carcinoma.
• To evaluate EVPL with postoperative irradiation for T2 glottic cancer with impaired vocal cord mobility.

Main Methods:

• Retrospective review of 26 patients with T1b or T2 glottic squamous cell carcinoma treated with EVPL.
• Patients were stratified based on tumor stage, mobility, and anterior commissure involvement.
• Treatment arms included surgery alone (T1b, T2a) or surgery followed by irradiation (T2 with impaired mobility).

Main Results:

• EVPL alone achieved 100% local control for T1b and T2a glottic cancers, including those with >50% anterior commissure involvement.
• For T2 glottic cancers with impaired vocal cord mobility (T2ai, T2bi), EVPL with postoperative irradiation yielded an 84.5% local control rate.
• Overall survival was 88.5%, with two recurrences salvaged by total laryngectomy.

Conclusions:

• EVPL is a highly effective organ-preserving surgical option for T1b and T2a glottic squamous cell carcinoma.
• Combined EVPL and postoperative irradiation provides good local control for select T2 glottic cancers with compromised vocal cord mobility.
• EVPL offers a distinct advantage over traditional cordectomy, preserving laryngeal function while achieving oncologic control.