The pedicled ventricular mucosal flap to prevent anterior glottic web after transoral laser surgery in T1b glottic cancer.

Abstract

Purpose: To introduce a novel technique utilizing a pedicled ventricular mucosal flap (PVMF) following one-stage, radical resection of T1b glottic cancer with anterior commissure involvement by transoral laser surgery, and to explore the oncological and functional outcomes, as well as its efficacy in preventing postoperative anterior glottic web formation.

Methods: Twelve patients diagnosed with T1bN0M0 glottic cancer involving anterior commissure underwent one-stage, radical resection of tumor by transoral laser surgery combined with PVMF between January 2021 and June 2023. The relative vocal fold length and Voice Handicap Index-10(VHI-10) scores at 6 months postoperatively were measured. The 1-year local control rate was measured.

Results: The median age was 64.5 years (range, 50-85). The median follow-up time was 19.5 months (range, 12-37 months). The 1-year local control rate was 100%. The healed pedicled ventricular mucosal flap exhibited the appearance of a mucosal eminence with smooth surface at the anterior part of the glottic region. The mean relative vocal fold length was 0.80 ± 0.23. At 6 months postoperatively, 50% (6/12) had no anterior glottic web formation. The median VHI-10 scores preoperatively and at 6 months postoperatively was 19.3 ± 3.9 (range, 11-24) and 10.0 ± 7.3 (range, 3-28) respectively, showing a significant difference (P < 0.05).

Conclusion: Transoral laser surgery combined with PVMF is an effective, stent-less, one-stage surgical approach for selective T1bN0M0 glottic cancer with anterior commissure involvement, effectively reducing the risk of anterior glottic web formation. The oncological outcomes in the cohort are promising, with 1-year local control rate of 100%; however, long-term follow up is still necessary.