Comparison Of Open Surgery And Endoscopic Laryngeal Surgery In The Treatment Of Early Glottic Carcinoma Involving Anterior Commissure

Objective: To analyze and compare the efficacy of open surgery and endoscopic laryngeal surgery in the treatment of early glottic carcinoma involving anterior union,so as to provide reference for clinical treatment.Methods: We retrospectively analyzed clinical datas of 91 patients with early glottic carcinoma involving anterior commissure who were treated by surgery in the otorhinolaryngology department of the frist affiliated hospital of guangxi medical university during March 2013 to November 2018.There were 47 cases in laryngeal endoscopic surgery group,including T1a(n = 25),T1b(n = 10)and T2(n = 12),and 44 cases in open surgery group,including T1a(n = 7),T1b(n =7)and T2(n = 30).The intraoperative bleeding,operation duration,hospitalization cost,postoperative articulation function,swallowing and breathing function,complications and recurrence rate,and Survival rates of the two groups of patients were compared,from which the curative effects of the two kinds of operations were summarized.Results: The follow-up time was 7-95 months,and its median time was 37 months.There were 38 patients surviving in the open operation group(n = 44),in which the 3-year survival rate was 92.7%,compared with 44 patients in the laryngeal endoscopic surgery group(n = 47),in which the 3-year survival rate was 93.5%.There was no significant difference in survival rate between the two groups(P >0.05).The overall 3-year survival rate was 92.5% and the 5-year survival rate was 81.3%.There were 7 patients relapsed in the open surgery group,in which the 3-year recurrence rate was 11.8% and the 5-year recurrence rate was21.4%,while 15 patients relapsed in the laryngoscope group,in which the 3-year recurrence rate was 34.4%(P < 0.05).The median length of hospital stay was 27 days in the open surgery group and 10 days in the laryngoscope group(P <0.05).The median hospitalization cost was 39154 yuan in the open surgery group and 18859 yuan in the laryngoscope group(P < 0.05).The operation time was about 140 minutes in the open surgery group and about 80 minutes in the laryngoscope group(P < 0.05).The intraoperative blood loss was about 80 ml in the open operation group and about 3 ml in the laryngoscope group(P < 0.05).The postoperative voice quality was poor in the open operation group and intermediate in the laryngoscope group,in which the difference was statistically significant(p < 0.05).All patients in the open operation group needed tracheotomy and nasal feeding,while those in the laryngoscope group needn’t(p< 0.05).Before discharge,Open surgery group has 27 patients underwent tracheotomy extubation,of which the extubation rate was 61.4% and the average extubation time was 21 days,and 40 patients underwent nasogastric tube extubation,of which the extubation rate was 90.9% and the average extubation time was 14 days.One year after operation,there were 43 patients underwent tracheotomy extubation,of which the extubation rate was 97.7% and the average extubation time was 38 days,and 44 patients underwent nasogastric tube extubation,of which the extubation rate was 100% and the average extubation time was 15 days.There was no significant difference in age,smoking,drinking,diabetes,hypertension,tumor differentiation,tumor location,positive cutting edge,postoperative radiotherapy and postoperative complications between the two groups(p > 0.05).Conclusion: Open surgery for early glottic carcinoma involving anterior commissure has a lower recurrence rate than laryngeal endoscopic surgery.However,laryngeal endoscopic surgery for patients with early glottic carcinoma involving anterior union has less surgical injury,faster postoperative recovery,lower hospitalization time and cost,better sound quality and higher quality of life.