Oncologic outcomes of transoral endoscopic plasma radiofrequency surgery for early-stage glottic laryngeal cancer with anterior commissure involvement

OBJECTIVE: Early-stage glottic laryngeal cancer with anterior commissure (AC) involvement poses unique challenges due to poor surgical exposure. Transoral endoscopic Plasma Radiofrequency microsurgery (TRM) offers promising alternatives with enhanced precision and cutting efficiency. This study is to explore oncologic outcomes of early-stage AC-involved glottic laryngeal cancer underwent transoral endoscopic plasma radiofrequency surgery. METHOD: We enrolled 65 patients with T1-T2N0M0 glottic laryngeal cancer involving the AC who underwent transoral plasma radiofrequency microsurgery (TRM) at Peking Union Medical College Hospital between 2008 and 2020. All patients received standardized surgical procedures. Patients were stratified into three subgroups (AC1/AC2/AC3) based on the extent of AC involvement, and also divided into high-risk and low-risk subgroups according to preoperative and intraoperative assessment of AC exposure. All patients were followed up to collect survival data, and survival analyses were performed across different subgroups to compare overall survival (OS), disease-specific survival (DSS), and laryngeal organ preservation (LOP). RESULTS: At 3 and 5 years, OS and DSS rates were 95.2% and 96.7%, respectively. LOP rates were 87.3% (3 years) and 83.5% (5 years). AC1 patients achieved 100% survival, while AC2 and AC3 groups had slightly lower, non-significant differences (P = 0.53, 0.25, and 0.32, respectively). High-risk exposure cases demonstrated comparable outcomes to low-risk cases (P = 0.54, 0.58, and 0.39, respectively), highlighting TRM's efficacy even under challenging conditions. CONCLUSIONS: Transoral endoscopic plasma radiofrequency surgery offers excellent long-term oncologic outcomes. TRM is a viable alternative to open surgery for patients with anterior commissure-involved glottic laryngeal cancer who are not candidates for transoral laser surgery. LEVEL OF EVIDENCE: 3.