Longitudinal Voice Outcomes Following Advanced CO2 Laser Cordectomy for Glottic Cancer.

Objective: 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.