Combined endoscopic and open frontolateral laryngectomy for glottic tumors involving the anterior commissure

The combined endoscopic and open frontolateral laryngectomy technique has been proposed to balance oncologic safety with functional preservation in the management of glottic tumors involving the Anterior Commissure (AC). This study aims to describe this technique in detail, its indications, and to present our institution's case series.

A retrospective review was conducted of all patients undergoing surgery for glottic lesions suspected of malignancy between 2017 and 2024 at a single institution. Patients treated with the combined endoscopic and open frontolateral laryngectomy approach were included. Surgical technique, indications, contraindications, and perioperative management were documented. Outcomes assessed included oncologic control, tracheostomy status, and laryngeal function.

Among 138 patients treated surgically for suspected malignant glottic lesions, four patients underwent the combined approach. Tumor stages included T1b (n = 2), T2 (n = 1), and T3 (n = 1). All patients were male, with a mean age of 71.5-years. Local disease control was achieved in three patients (75%), while one T3 patient experienced recurrence requiring salvage radiotherapy, achieving subsequent disease control. All patients retained laryngeal function, with no need for permanent tracheostomy or reports of dysphagia. Postoperative dysphonia was characterized by roughness, breathiness, and high-pitched but functional voices.

The combined approach offers a feasible alternative for managing AC-involving glottic tumors, providing oncologic safety while preserving function. It enables precise tumor resection with limited sacrifice of normal tissue and the potential for phonation-preserving reconstruction. Given the small sample size, further studies are needed to validate its efficacy and long-term benefits.