Voice outcomes from subligamentous cordectomy for early glottic cancer

Objectives: We evaluated the voice and vocal fold pliability outcomes of European Laryngological Society (ELS) deep type I (subepithelial) and type II (subligamentous) cordectomies for early glottic cancer. Methods: We reviewed the medical records of patients with glottic carcinoma at a tertiary care medical center between 2005 and 2011. Their procedures were stratified into ELS type I and ELS type II cordectomies. The data recorded included age, gender, tumor stage, recurrence, patient-assessed voice-related quality of life, perceptual voice evaluation, and stroboscopy. Results: Four patients were identified as having subepithelial cordectomy, and 13 as having subligamentous cordectomy. The average preoperative and postoperative voice-related quality of life scores were 65 and 74 for the ELS I cohort and 64 and 95 for the ELS II group. The preoperative and postoperative perceptual voice evaluation scores were 56 and 35 for the ELS I cohort and 45 and 21 for the ELS II cohort. The ELS I cohort had a moderately to severely reduced mucosal wave, with 75% of patients demonstrating glottic insufficiency, whereas the ELS II cohort had a mildly to moderately reduced mucosal wave, with 8% of patients demonstrating glottic insufficiency. The survival outcomes were the same. Conclusions: Patients who underwent subligamentous excision of early glottic cancer had significantly improved postoperative voice and stroboscopy scores. This finding suggests that if tumor resection reaches the vocal ligament, and minimal superficial lamina propria can be preserved, subligamentous cordectomy should be performed.