PURPOSE: To evaluate voice quality evolution after a transoral laser cordectomy (TLC) for precancerous lesions and early glottic cancer. METHODS: This prospective study enrolled 18 patients scheduled for TLC for high-grade dysplasia, Tis, T1, and T2 glottic squamous cell cancers, from May 2017 to March 2020. Patients were grouped according to the extent of TLC: Group I (n = 11, 61.1%): unilateral subepithelial or subligamental cordectomy; Group II (n = 7, 38.9%): unilateral transmuscular, total, or extended cordectomy. Voice quality parameters, including dysphonia grade (G), roughness (R), breathiness (B), maximal phonation time (MPT), jitter, and shimmer, were evaluated before, and at 6 weeks and 6 months after the TLC. RESULTS: In Group I, the degree of G and R items remained without substantial improvement 6 weeks after surgery; however, improved above the pre-surgery level up to 6 months after surgery. The MPT, jitter, and shimmer did not change significantly at 6 weeks or 6 months post-TLC. In Group II, G, R, and B remained significantly impaired even 6 months post-surgery. Jitter, and shimmer worsened at 6 weeks, but reached preoperative levels at 6 months post-surgery. MPT was significantly worse at 6 weeks and remained deteriorated at 6 months post-surgery. All measured parameters were significantly worse in Group II than in Group I at 6 weeks and 6 months post-surgery. No patient required a phonosurgical procedure. CONCLUSION: After a TLC, voice quality evolution depended on the extent of surgery. It did not improve at 6 weeks post-surgery. Improvements in less extent cordectomies occurred between 6 weeks and 6 months post-surgery. Understanding voice development over time is important for counseling patients when considering phonosurgical procedures.

Department of Craniofacial Surgery Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Otorhinolaryngology and Head and Neck Surgery University Hospital Ostrava 17 Listopadu 1790 708 52 Ostrava Czech Republic

Zobrazit více v PubMed

McGuirt WF, Blalock D, Koufman JA, Feehs RS. Voice analysis of patients with endoscopically treated early laryngeal carcinoma. Ann Otol Rhinol Laryngol. 1992;101:142–146. doi: 10.1177/000348949210100207. PubMed DOI

Cragle SP, Brandenburg JH. Laser cordectomy or radiotherapy: cure rates, comunication, and cost. Otolaryngol Head Neck Surg. 1993;108:648–654. doi: 10.1177/019459989310800605. PubMed DOI

Brandenburg JH. Laser cordotomy versus radiotherapy: an objective cost analysis. Ann Otol Rhinol Laryngol. 2001;110:312–318. doi: 10.1177/000348940111000404. PubMed DOI

Ansarin M, Santoro L, Cattaneo A, Massaro MA, Calabrese L, Giugliano G, Maffini F, Ostuni A, Chiesa F. Laser surgery for early glottic cancer: impact of margin status on local control and organ preservation. Arch Otolaryngol Head Neck Surg. 2009;135(4):385–390. doi: 10.1001/archoto.2009.10. PubMed DOI

Vaculik MF, MacKay CA, Taylor SM, Trites JRB, Hart RD, Rigby MH. Systematic review and meta-analysis of T1 glottic cancer outcomes comparing CO2 transoral laser microsurgery and radiotherap. J Otolaryngol Head Neck Surg. 2019;48(1):44. doi: 10.1186/s40463-019-0367-2. PubMed DOI PMC

Gioacchini FM, Tulli M, Kaleci S, Bondi S, Bussi M, Re M. Therapeutic modalities and oncologic outcomes in the treatment of T1b glottic squamous cell carcinoma: a systematic review. Eur Arch Otorhinolaryngol. 2017;274(12):4091–4102. doi: 10.1007/S00405-017-4736-Z. PubMed DOI

Brondbo K, Benninger MS. Laser resection of T1a glottic carcinomas: results and postoperative voice quality. Acta Otolaryngol. 2004;124:976–979. doi: 10.1080/00016480410017413. PubMed DOI

Vilaseca I, Huerta P, Blanch JL, Fernández-Planas AM, Jiménez C, Bernal-Sprekelsen M. Voice quality after CO2 laser cordectomy – what can we really expect? Head Neck. 2008;30(1):43–49. doi: 10.1002/hed.20659. PubMed DOI

Roh JL, Kim DH, Kim SY, Park CI. Quality of life and voice in patients after laser cordectomy for Tis and T1 glottic carcinomas. Head Neck. 2007;29(11):1010–1016. doi: 10.1002/hed.20625. PubMed DOI

Peretti G, Piazza C, Balzanelli C, Mensi MC, Rossini M, Antonelli AR. Preoperative and postoperative voice in Tis-T1 glottic cancer treatment by endoscopic cordectomy: an additional issue for patient counseling. Ann Otol Rhinol Laryngol. 2003;112:759–763. doi: 10.1177/000348940311200903. PubMed DOI

Remacle M, Eckel HE, Antonelli A, Brasnu D, Chevalier D, Friedrich G, Olofsson J, Rudert HH, Thumfart W, de Vincentiis M, Wustrow TPU. Endoscopic cordectomy. a proposal for a classification by the Working Committee, European Laryngological Society. Eur Arch Otorhinolaryngol. 2000;257:227–231. doi: 10.1007/s004050050228. PubMed DOI

Hirano M. Clinical examination of voice, NewYork: Springer Verlag; 1981. pp. 3–20.

Staníková L, Šatanková J, Kučová H, Walderová R, Zeleník K, Komínek P. The role of narrow-band imaging (NBI) endoscopy in optical biopsy of vocal cord leukoplakia. Eur Arch Otorhinolaryngol. 2017;274(1):355–359. doi: 10.1007/s00405-016-4244-6. PubMed DOI

Rosier JF, Gregoire V, Counoy H, et al. Comparison of external radiotherapy, laser microsurgery and partial laryngectomy for the treatment of T1N0M0 glottic carcinomas: a retrospective evaluation. Radiother Oncol. 1998;48:175–183. doi: 10.1016/S0167-8140(98)00058-9. PubMed DOI

Smith JC, Johnson JT, Myers EN. Management and outcome of early glottic carcinoma. Otolaryngol Head Neck Surg. 2002;126:356–364. doi: 10.1067/mhn.2002.123858. PubMed DOI

Mendenhall WM, Werning JW, Hinerman RW, Amdur RJ, Villaret DB. Management of T1–T2 glottic carcinomas. Cancer. 2004;100:1786–1792. doi: 10.1002/cncr.20181. PubMed DOI

Baird BJ, Sung CK, Beadle BM, Divi V. Treatment of early-stage laryngeal cancer: a comparison of treatment options. Oral Oncol. 2018;87:8–16. doi: 10.1016/j.oraloncology.2018.09.012. PubMed DOI

Du Y, Shao S, Lv M, Zhu Y, Yan L, Qiao T. Radiotherapy versus surgery-which is better for patients with T1–2N0M0 glottic laryngeal squamous cell carcinoma? Individualized survival prediction based on web-based nomograms. Front Oncol. 2020;10:1669. doi: 10.3389/fonc.2020.01669. PubMed DOI PMC

Prettyjohns M, Winter S, Kerawala C, Paleri V. Transoral laser microsurgery versus radiation therapy in the management of T1 and T2 laryngeal glottic carcinoma: which modality is cost-effective within the UK? Clin Otolaryngol. 2017;42(2):404–415. doi: 10.1111/coa.12807. PubMed DOI

Rydell R, Schalen L, Fex S, Elner A. Voice evaluation before and after laser excision vs. radiotherapy of T1a glottic carcinoma. Acta Otolaryngol. 1995;115(4):560–565. doi: 10.3109/00016489509139367. PubMed DOI

Peeters AJGE, van Gogh CDL, Goor KM, et al. Health status and voice outcome after treatment for T1a glottic carcinoma. Eur Arch Otorhinolaryngol. 2004;261:534–540. doi: 10.1007/s00405-003-0697-5. PubMed DOI

Spielmann PM, Majumdar S, Morton RP. Quality of life and functional outcomes in the management of early glottic carcinoma: a systematic review of studies comparing radiotherapy and transoral laser microsurgery. Clin Otolaryngol. 2010;35:373–382. doi: 10.1111/j.1749-4486.2010.02191.x. PubMed DOI

Krengli M, Policarpo M, Manfredda I, et al. Voice quality after treatment for T1a glottic carcinoma—radiotherapy versus laser cordectomy. Acta Oncol. 2004;43:284–289. doi: 10.1080/02841860410026233. PubMed DOI

Arias F, Arraras JI, Asin G, Uzcanga MI, Enrique Marav E, Chicata V, Eito C, Zarandona U, Mora I, Vila M, Domínguez MA. Quality of life and voice assessment in patients with early-stage glottic cancer. Head Neck. 2014;37(3):340–346. doi: 10.1002/hed.23603. PubMed DOI

Fink DS, Sibley 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(2):405–407. doi: 10.1002/lary.25442. PubMed DOI

Peretti G, Piazza C, Balzanelli C, Cantarella G, Nicolai P. Vocal outcome after endoscopic cordectomies for Tis and T1 glottic carcinomas. Ann Otol Rhinol Laryngol. 2003;112(2):174–179. doi: 10.1177/000348940311200212. PubMed DOI

Aaltonen LM, Rautiainen N, Sellman J, Saarilahti K, Mäkitie A, Rihkanen H, Laranne J, Kleemola L, Wigren T, Sala E, Lindholm P, Grenman R, Joensuu H. Voice quality after treatment of early vocal cord cancer: a randomized controlled trial comparing laser surgery with radiation therapy. Int J Radiat Oncol Biol Phys. 2014;90:255–270. doi: 10.1016/j.ijrobp.2014.06.032. PubMed DOI

van Loon Y, Hendriksma M, Heijnen BJ, et al. Voice outcome after unilateral ELS type III or bilateral type II resections for T1–T2 glottic carcinoma: results after 1 year. Head Neck. 2019;41:1638–1647. doi: 10.1002/hed.25582. PubMed DOI PMC

Villaret AB, Piazza C, Redaelli De Zinis LO, Cattaneo A, Cocco D, Peretti G. Phonosurgery after endoscopic cordectomies I. Primary intracordal autologous fat injection after transmuscular resection: preliminary results. Eur Arch Otorhinolaryngol. 2007;264:1179–1184. doi: 10.1007/s00405-007-0331-z. PubMed DOI

Remacle M, Lawson G, Hedayat A, Trussart C, Jamart J. Medialization framework surgery for voice improvement after endoscopic cordectomy. Eur Arch Otorhinolaryngol. 2001;258:267–271. doi: 10.1007/s004050100350. PubMed DOI

Zeitels SM, Hillman RE, Franco RA, Bunting GV. Voice and treatment outcome from phonosurgical management of early glottic cancer. Ann Otol Rhinol Laryngol. 2002;190:3–20. doi: 10.1177/0003489402111s1202. PubMed DOI