Comparison of oncological outcomes between transoral laser microsurgery and open partial laryngectomy in T2 glottic carcinoma with anterior commissure involvement.

PURPOSE: The optimal surgical management for T2 glottic cancer involving the anterior commissure (AC) remains controversial, with debate centered on transoral laser microsurgery (TOLMS) versus open partial laryngectomy (OPL). This study aims to compare the oncological outcomes of these two surgical approaches. METHODS: A retrospective analysis included 152 patients with primary T2 glottic cancer involving the AC, initially treated between 2012 and 2022 (38 TOLMS, 114 OPL). Primary endpoints were overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), local control (LC), and regional control (RC). Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards models. RESULTS: The OPL group showed superior 5-year outcomes: OS (93.6% vs. 65.2%, HR = 0.343, 95% CI: 0.139–0.845, P = 0.020), DFS (90.6% vs. 60.5%, HR = 0.349, 95% CI: 0.152–0.805, P = 0.014), DSS (95.9% vs. 79.2%, HR = 0.142, 95% CI: 0.043–0.473, P = 0.001), and LC (97.2% vs. 75.8%, HR = 0.069, 95% CI: 0.015–0.327, P < 0.001). Subgroup analysis revealed that for unilateral tumors, OPL had a significant advantage in all endpoints. For bilateral tumors, there were no statistically significant differences in OS, DFS, or DSS between groups, although LC remained superior with OPL. CONCLUSION: OPL was associated with superior oncological control for T2 glottic cancer with AC involvement. In patients with bilateral tumors, survival outcomes were not statistically different between approaches in this study; however, the role of TOLMS requires further validation in hyperselected patients. Treatment should be individualized based on tumor extent, patient preference, and surgical expertise.