surgical treatment of laryngeal cancer

Patients of T1b laryngeal cancer involving anterior vocal commissure(AVC) were treated with middle frontal horizontal partial laryngectomy(MFHPL) or anterior frontal vertical partial laryngectomy (AFVPL) . MFHPL: A window of cartilage was made by cuts from upper 1/3 (about 0.5 cm to the superior aspect of the cartilage) and lower 1/3 (about 0.5 cm to the inferior aspect of the cartilage) in the midline to the middle of the posterior aspects of the cartilage. Larynx was then entered by transecting the intralaryngeal mucosa/muscles through one of the cartilage incisions that was farther from the AVC, based on the anatomical relationship between the AVC and cartilage indicated by CT. The tumor was then resected under direct vision with tumor free margins of over 5 mm. Stitches entered at the upper cartilage lamina and came out at the lower vestibular mucosa, then entered at the lower aspect of thyroid cartilage lamina and came out at the subglottic mucosa. These four stitches were aligned and tied to close the larynx. AFVPL:The vertical outline was made along the anterior aspect of the thyroid lamina with 3-5 mm deviation towards the less involved side, and approximately 8-12 mm deviation towards the more severely involved side. A vertical incision was made with a saw on bilateral thyroid laminas. The laryngeal cavity was visualized and approached through the less involved side. The true and false cords interior to the frontolateral thyroid cartilage were resected along with subglottic soft tissues, with tumor margins of over 5 mm. Depending on the extent of the laryngeal defects, the laryngeal cavity was closed directly or reconstructed using sternohyoid myofascia (single or double pedicles), or sternohyoid perichondrium. Both AFVPL and MFHPL are about 1 and a half hours procedure, performed once only. The postoperative complications, voice quality and survival rates were evaluated and compared .