The limitations of trans-oral endoscopic laser resection in the management of laryngeal cancer with anterior commissure involvement: retrospective, cross sectional studies and review of clinical experience

Abstract Aim of the work This study assesses the limitations of transoral laser microsurgery (TLM) for early-stage laryngeal cancer involving the anterior commissure (AC), specifically examining the relationship between recurrence and thyroid cartilage invasion. Patients and methods A retrospective review of 32 T1–T2 glottic carcinoma patients treated with TLM between May 2023 and April 2025 analyzed recurrence and progression over 3–24 months. Concurrently, a cross-sectional analysis of five laryngectomy specimens from recurrent cases evaluated AC involvement and thyroid cartilage invasion. Results The cohort comprised 19 T1 and 13 T2 tumors. Recurrence occurred in 22 patients (54%), with 14 (63.6%) recurring at the same stage and 8 (36.4%) progressing. Salvage treatment consisted of 15 conservative surgeries (68.2%) and 7 total laryngectomies (31.8%). Histological analysis of all five laryngectomy specimens revealed tumor involvement of the cartilage. Conclusions AC involvement significantly impacts prognosis in early-stage laryngeal cancer. Given the increased recurrence risk after TLM or DRT associated with AC, vocal cord, supraglottic, or subglottic involvement, and the potential need for total laryngectomy, conservative surgical approaches should be considered cautiously in these cases.