Middle frontal horizontal partial laryngectomy (MFHPL): a treatment for stage T1b squamous cell carcinoma of the glottic larynx involving anterior vocal commissure

Abstract

Objective: The therapeutic effect of middle frontal horizontal partial laryngectomy (MFHPL) in treating stage T1b squamous cell carcinoma of the glottic larynx involving anterior vocal commissure (AVC) was compared with that of the anterior frontolateral vertical partial laryngectomy (AFVPL). The feasibility and practical significance of MFHPL in clinical application was discussed in the present study.

Methods: From January 1996 to January 2010, a total of 65 patients diagnosed with stage T1bN0M0 glottic laryngeal cancer were treated with MFHPL or AFVPL. The postoperative complications, glottic reconstruction, recurrence rate, voice quality and survival rates were evaluated and compared between two treatments.

Results: AFVPL and MFHPL were performed in 34 and 31 patients, respectively. Flexible fiberoptic laryngoscopy revealed that in the MFHPL-treated patients the reconstructed glottis was spacious and symmetric. In contrast, AFVPL treatment resulted in irregular glottic area with poor symmetry and tubular glottis. The incidence of postoperative laryngeal stenosis significantly differed between the MFHPL- and AFVPL-treated groups (P = 0.025). No significant difference was detected in the 3- and 5-year overall- or tumor-free survival rates between two treatments. The Voice Handicap Index (VHI) and maximum phonation time (MPT) after surgery were 51.0±12.99 and 12.42±3.44 sec in the AFVPL-treated group; while in the MFHPL-treated patients they were 31.81±7.48 and 7.65±1.98 sec, respectively. Both differences in VHI (P = 0.012) and MPT (P = 0.024) were significant between two treatments.

Conclusions: MFHPL was comparable to AFVPL with respect to postoperative complications, recurrence rate and survival rates, but possessed advantages over AFVPL in terms of the incidence of laryngeal stenosis and voice quality. Our study indicated that MFHPL has a potential value in clinical practice of treating stage T1b squamous cell carcinoma of the glottic larynx involving AVC.

Figure 1. Diagram of MFHPL procedure.

A: The thyroid cartilage was incised horizontally; B: Larynx was entered through the supra- or sub-glottis; C: Tissue defect after removal of the middle part of larynx together with tumor under direct vision; D: The larynx was tied and sutured; E: Resected tissue.; F: The anatomical relationship between the AVC and cartilage indicated by spiral CT.

Figure 2. Schematic diagram of MFHPL.

A: Dotted line indicates the resection area within the larynx during MFHPL; B, C: Dotted line indicates the resection area of thyroid cartilage during MFHPL.

Figure 3. Schematic diagram of AFVPL.

Dotted line indicates the resection area of thyroid cartilage during AFVPL.

Figure 4. Pre- and post-surgery glottis of patients receiving MFHP.

A: The preoperative glottis under laryngoscopy; B: The postoperative glottis under laryngoscopy 6 months after procedure. C: The preoperative glottis under contrast-enhanced spiral CT.

Figure 5. Kaplan-Meier curve for overall survival of 57 patients received either MFHPL or AFVPL procedure.

0: AFVPL group; 1: MFHPL group.

Figure 6. Kaplan-Meier curve for tumor-free survival of 57 patients received either MFHPL or AFVPL procedure.

0: AFVPL group; 1: MFHPL group.