Longitudinal Voice Outcomes Following Advanced CO₂ Laser Cordectomy for Glottic Cancer

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• 作者：Abie H. Mendelsohn^&lowast ; ; ^{AMendelsohn@mednet.ucla.edu" class="auth_mail" title="E-mail the corresponding author} ; Nayla Matar^&dagger ; ; Vincent Bachy^&Dagger ; ; Georges Lawson^&Dagger ; ; Marc Remacle^&Dagger ;
• 关键词：Cancer ; Vocal fold ; Vocal cord ; VHI ; Radiation ; Laryngeal preservation
• 刊名：Journal of Voice
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：29
• 期：6
• 页码：772-775
• 全文大小：991 K

文摘

CO₂ laser cordectomy for glottic carcinoma offers excellent oncologic control on a per stage basis as compared with primary radiotherapy. We aim to further investigate the fluctuations of postoperative vocal outcomes following extended laser cordectomy for glottic cancer.

Design

Single center retrospective cohort study.

Methods

Eleven patients with glottic squamous cell carcinoma (SCC) who received CO₂ laser cordectomy European Laryngological Society type III-IV with complete datasets at preoperative, immediate postoperative (within 4 months), and delayed (greater than 6 months) time points were included.

Results

All patients (n = 11) received cordectomy as their primary treatment. Tumor stage was divided evenly between T1 and T2. One patient was referred for post-cordectomy thyroplasty. Mean Voice Handicap Index (VHI) scores increased in the immediate postoperative period (43.3–46.2) but did not reach significance (P > 0.05). Delayed postoperative VHI (23.3) demonstrated substantial improvement from both pre- and immediate postoperative levels (P = 0.047). Objective voice rating significantly declined initially (P = 0.03; Grade, P = 0.01; Breathiness) and recovered to similar preoperative levels. Maximum phonation time (MPT) showed substantial decreases at the initial postoperative period (P = 0.007). Although significant improvement was made at the delayed postoperative point (P = 0.009), MPT remained below the preoperative level (P = 0.028). No significant changes were seen in phonatory subglottic pressures.

Conclusions

Patients undergoing extended CO₂ laser cordectomy for glottic cancers can experience initial decline in voice quality; however, vocal function routinely returns to preoperative levels following the initial healing period. A small percentage of extended cordectomy patients may require further vocal interventions.