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Objectives: To assess oncologic and functional outcomes of early glottic cancer cases treated with transoral laser microsurgical resection (TLMR) and to outline the principles for optimizing vocal outcomes in these cases. Materials and methods: Sixty six patients with early glottic cancer (7 CIS, 43 T1a, 15 T1b, 1 T2) underwent TLMR. Postoperatively, voice quality was assessed by Oates Russell Voice Profile. Results: Local control was achieved in 95.08% of the cases and larynx was preserved in 98.3%. Residual disease developed in 3 patients. There were eight local recurrences. Single patient of T1b lesion was lost to follow-up and came back with stridor and underwent total laryngectomy. Conclusion: Early glottic cancers can be effectively treated by TLMR with good oncologic outcome. Depth of infiltration of lesion is the most critical factor affecting the postoperative vocal outcome. In our study near-normal conversational voice to moderate change in voice was found after type I, II, and III cordectomies. Surprisingly, type VI cordectomy also gave a serviceable vocal outcome with moderate change in voice. In our opinion, type IV cordectomy does not give a serviceable vocal outcome even if performed unilaterally. Thus radiotherapy should be strongly considered in such cases for better vocal outcome.

Our Approach for Optimizing Vocal Outcomes in Transoral Laser Microsurgical Resection of Early Glottic Carcinoma