Importance of anterior commissure in recurrence of early glottic cancer after laser endoscopic resection

Objective: To analyze the impact of anterior commissure involvement on rates of local control, recurrence, and laryngeal preservation in patients with early glottic cancer (T1a-T2 lesions, staged according to the TNM staging system) treated with laser microsurgical resection. Design: Retrospective review. Setting: A tertiary university referral center. Patients: Forty-eight patients with early glottic (T1-T2a) cancer. Intervention: Laser endoscopic resection of glottic cancer. Main Outcome Measures: Evaluation of local control and larynx preservation rates. Results: Among 48 patients presenting with early glottic cancer, the anterior commissure was involved in 24 cases. The local control rate was 79% (19 cases), and the larynx preservation rate was 96% (23 cases). In the 24 cases without anterior commissure involvement, the local control rate was 96% (23 cases) and the corresponding larynx preservation rate was 100% (24 cases). The rate of local recurrence with anterior commissure involvement was 21% (5 cases) and was 4% (1 case) when this site was not compromised by the tumor. This difference was not statistically significant (P=.08). When the anterior commissure was compromised by a lesion, more surgical margins taken from the patient after the completion of surgery (additional margins) were compromised by squamous cell carcinoma (SCC) on permanent section (33% [8 cases]) compared with 0% from patients with anterior commissure involvement (P=.003), despite the fact that these margins were negative for disease on frozen section. Cases with additional margins compromised by SCC on permanent section (P=.004) and T1 lesions (P=.009) had a higher rate of recurrence. Conclusions: This study shows the tendency toward greater additional margins compromised by SCC and a higher rate of tumor recurrence in lesions with anterior commissure involvement after laser microsurgery for early glottic carcinoma. Higher recurrence rates were observed in cases with compromised additional margins and in T1 cases.