Organ preservation surgery for laryngeal squamous cell carcinoma: Low incidence of thyroid cartilage invasion

Objectives/Hypothesis: Determine the incidence and risk factors for thyroid cartilage invasion in early and midstage laryngeal cancer. Study Design: Retrospective review. Methods: A retrospective review was carried out of tumors treated by open surgery with at least partial resection of thyroid cartilage from 1992 to 2008. Preoperative laser, radiation therapy, or chemotherapy were excluded. Tumor stage, anterior commissure involvement, vocal fold (VF) mobility, computed tomography (CT) scan, and pathological cartilage status were recorded. Results: Three hundred fifty-eight patients were treated for tumors staged cT1 (32%), cT2 (53%), and cT3 (15%) by vertical (26%), supracricoid (62%), or supraglottic partial laryngectomy (12%). The thyroid cartilage was invaded in 8.9% of cases. Abnormal VF mobility was significantly related to thyroid cartilage invasion (Fisher exact test, P = .0002). Neither anterior commissure involvement nor CT scan were related to cartilage invasion. Conclusions: Thyroid cartilage invasion was rare but increased if VF mobility was impaired. This has implications for transoral resection, which unlike open surgery avoids unnecessary cartilage resection.