Middle Frontal Horizontal Partial Laryngectomy (MFHPL): A Treatment for Stage T1b Squamous Cell Carcinoma of the Glottic Larynx Involving Anterior Vocal Commissure

Abstract

ObjectiveThe 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.MethodsFrom 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.ResultsAFVPL 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.ConclusionsMFHPL 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.

Analiza 191 pacjentów z rakiem krtani w oparciu o nową klasyfikację otwartych poziomych laryngektomii częściowych według Europejskiego Towarzystwa Laryngologicznego z 2014 roku

“…Laryngektomie częściowe mają ugruntowaną pozycję w leczeniu raka krtani, a ich rozwój liczy już ponad pięć dekad [18,[20][21][22]. Liczne ośrodki publikujące wyniki leczenia w opisie procedury podawały miejsce zespolenia (cricohyoidoepiglotto-pexy; CHEP lub crico-hyoidopexy; CHP) bez precyzyjnego opisu granic, zwłaszcza górnych marginesów resekcji.…”

Comment to the article “Open partial horizontal laryngectomies: a proposal for classification by the working committee on nomenclature of the European Laryngological Society” by G. Succo et al.

“…The modification of the horizontal glottectomy and OPHL Type IIa was presented by Wen et al [ 5 ] and Maoxiao and Renyu [ 6 ]. This treatment option is available for T2 glottic tumors involving the AC and oncological, and functional results have confirmed the validity of this procedure [ 7 ].…”