Cricohyoidoepiglottopexy vs near-total laryngectomy with epiglottic reconstruction in the treatment of early glottic carcinoma

Objective: To compare functional and oncological outcomes of cricohyoidoepiglottopexy ( CHEP) and near-total laryngectomy with epiglottic reconstruction ( NTLER) techniques in early glottic carcinoma. Design: Case series, clinical study. Setting: Two tertiary care referral centers. Patients: Seventeen patients with T1b glottic squamous cell carcinoma were treated with CHEP and 21 were treated with NTLER. Main Outcome Measures: Fundamental frequency, maximum phonation time, maximum phonation intensity, Voice Handicap Index, and GRBAS ( grade, roughness, breathiness, asthenia, and strain) scale were used to evaluate voice. Nasogastric tube removal times and late postoperative aspiration scales were used to evaluate swallowing ability. Results: Fundamental frequency ( P=. 78), maximum phonation time ( P=. 44), and maximum phonation intensity ( P=. 94) measurements were not significantly different in the 2 groups. There was also no significant difference in mean Voice Handicap Index score ( P=. 62), mean decannulation time ( P=. 25), time to nasogastric tube removal ( P=. 12), or clinical grades of late postoperative aspiration ( P=. 87) between the 2 groups. The mean Voice Handicap Index score was 55.58 in the CHEP group and 52.78 in the NTLER group. According to the GBRAS scale, overall voice quality was moderately altered in both groups. All patients were successfully decannulated. In the CHEP and NTLER groups, the mean decannulation times were 27 and 20 days, respectively, and the nasogastric tubes were removed after an average of 23 and 17 days. The overall ( Kaplan- Meier) survival rate was 94% in the patients who underwent CHEP and 90% in the patients who underwent NTLER ( P=. 76). The disease-free survival rates were 100% and 76% in the CHEP and NTLER groups, respectively ( P=. 07). Conclusions: Functional and oncological results appear to be similar with both treatment methods. If open surgery is planned, the choice between these procedures mainly depends on the experience and preference of the surgeon.