European Archives of Oto-Rhino-Laryngology

, Volume 273, Issue 2, pp 447–453 | Cite as

The incidence of thyroid cartilage invasion through the anterior commissure in clinically early-staged laryngeal cancer

  • Murat Ulusan
  • Selin Unsaler
  • Bora BasaranEmail author
  • Dilek Yılmazbayhan
  • Ismet Aslan
Head and Neck


In this study, the incidence of thyroid cartilage invasion in early-stage laryngeal tumors involving anterior commissure was assessed. Medical charts and pathology reports of 62 patients who underwent supracricoid partial laryngectomy as the primary treatment of early-staged laryngeal squamous cell carcinoma were retrospectively reviewed. Patients were divided into two groups according to the macroscopic examination of the surgical specimen: tumors limited to the glottis with the involvement of anterior commissure (TLG); tumors invading both supraglottis and glottis with the involvement of anterior commissure (TISG). Thirty-seven of the cases were classified as TLG group (59.7 %) and the remaining 25 of them were classified as TISG group (40.3 %). Thyroid cartilage invasion was observed totally in ten patients (16.1 %), as macroscopic invasion in two cases and microinvasion in eight patients. Only two were in the TLG group (cartilage invasion rate of 5.4 %), the remaining eight were in the TISG group (cartilage invasion rate of 32 %). Thyroid cartilage invasion rate of TISG group was significantly higher than that of TLG group (p = 0.011, p < 0.05). Tumors limited to the glottis with AC involvement may be more suitable for endoscopic resection; on the contrary, tumors with vertical extension invading both AC and supraglottis should be evaluated more suspiciously due to high rate of thyroid cartilage invasion, which may still necessitate external laryngectomy techniques.


Laryngeal cancer Anterior commissure Thyroid cartilage Invasion 


Conflict of interest



  1. 1.
    Olofsson J (1975) Specific features of laryngeal carcinoma involving the anterior commissure and the subglottic region. Can J Otolaryngol 4(4):618–636PubMedGoogle Scholar
  2. 2.
    Bagatella F, Bignardi L (1983) Behavior of cancer at the anterior commissure of the larynx. Laryngoscope 93(3):353–356PubMedCrossRefGoogle Scholar
  3. 3.
    Bradley PJ, Rinaldo A, Suárez C, Shaha AR, Leemans CR, Langendijk JA et al (2006) Primary treatment of the anterior vocal commissure squamous carcinoma. Eur Arch Otorhinolaryngol 263(10):879–888PubMedCrossRefGoogle Scholar
  4. 4.
    Kirchner JA (1970) Cancer at the anterior commissure of the larynx. Results with radiotherapy. Arch Otolaryngol 91(6):524–525PubMedCrossRefGoogle Scholar
  5. 5.
    Rucci L, Gallo O, Fini-Storchi O (1991) Glottic cancer involving anterior commissure: surgery vs radiotherapy. Head Neck 13(5):403–410PubMedCrossRefGoogle Scholar
  6. 6.
    Zohar Y, Rahima M, Shvili Y, Talmi YP, Lurie H (1992) The controversial treatment of anterior commissure carcinoma of the larynx. Laryngoscope 102(1):69–72PubMedCrossRefGoogle Scholar
  7. 7.
    Pech A, Cannoni M, Giovanni A, Thomassin JM, Zanaret M, Goubert JL (1986) Requisite selection of surgical technics in the treatment of cancer of the larynx. Ann Otolaryngol Chir Cervicofac 103(8):565–575PubMedGoogle Scholar
  8. 8.
    Laccourreye O, Muscatello L, Laccourreye L, Naudo P, Brasnu D, Weinstein G (1997) Supracricoid partial laryngectomy with cricohyoidoepiglottopexy for “early” glottic carcinoma classified as T1–T2N0 invading the anterior commissure. Am J Otolaryngol 18(6):385–389PubMedCrossRefGoogle Scholar
  9. 9.
    Tucker HM, Benninger MS, Roberts JK, Wood BG, Levine HL (1989) Near-total laryngectomy with epiglottic reconstruction. Long-term results. Arch Otolaryngol Head Neck Surg 115(11):1341–1344PubMedCrossRefGoogle Scholar
  10. 10.
    Rizzotto G, Crosetti E, Lucioni M, Succo G (2012) Subtotal laryngectomy: outcomes of 469 patients and proposal of a comprehensive and simplified classification of surgical procedures. Eur Arch Otorhinolaryngol 269(6):1635–1646PubMedCrossRefGoogle Scholar
  11. 11.
    Succo G, Peretti G, Piazza C, Remacle M, Eckel HE, Chevalier D, Simo R, Hantzakos AG, Rizzotto G, Lucioni M, Crosetti E, Antonelli AR (2014) Open partial horizontal laryngectomies: a proposal for classification by the working committee on nomenclature of the European Laryngological Society. Eur Arch Otorhinolaryngol 271(9):2489–2496PubMedCrossRefGoogle Scholar
  12. 12.
    Hakeem AH, Tubachi J, Pradhan SA (2013) Significance of anterior commissure involvement in early glottic squamous cell carcinoma treated with trans-oral CO2 laser microsurgery. Laryngoscope 123(8):1912–1917PubMedCrossRefGoogle Scholar
  13. 13.
    Rödel RM, Steiner W, Müller RM, Kron M, Matthias C (2009) Endoscopic laser surgery of early glottic cancer: involvement of the anterior commissure. Head Neck 31(5):583–592PubMedCrossRefGoogle Scholar
  14. 14.
    Pearson BW, Salassa JR (2003) Transoral laser microresection for cancer of the larynx involving the anterior commissure. Laryngoscope 113(7):1104–1112PubMedCrossRefGoogle Scholar
  15. 15.
    Edge SB, Byrd DR, Compton CC et al (eds) (2010) AJCC cancer staging manual. 7th edn. Springer, New York, pp 57–62Google Scholar
  16. 16.
    Armstrong WB, Vokes DE, Maisel RH (2010) Malignant tumors of the larynx. In: Haughey BH, Robbins KT (eds) Cummings otolaryngology, head and neck surgery, 5th edn. Mosby-Elsevier, Philadelphia, pp 1482–1511CrossRefGoogle Scholar
  17. 17.
    Fernandes R, Gopalan P, Spyridakou C, Joseph G, Kumar M (2006) Predictive indicators for thyroid cartilage involvement in carcinoma of the larynx seen on spiral computed tomography scans. J Laryngol Otol 120(10):857–860PubMedCrossRefGoogle Scholar
  18. 18.
    Hartl DM, Landry G, Bidault F, Hans S, Julieron M, Mamelle G et al (2013) CT-scan prediction of thyroid cartilage invasion for early laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 270(1):287–291PubMedCrossRefGoogle Scholar
  19. 19.
    Barbosa MM, Araújo VJ Jr, Boasquevisque E, Carvalho R, Romano S, Lima RA et al (2005) Anterior vocal commissure invasion in laryngeal carcinoma diagnosis. Laryngoscope 115(4):724–730PubMedCrossRefGoogle Scholar
  20. 20.
    Beitler JJ, Muller S, Grist WJ, Corey A, Klein AM, Johns MM et al (2010) Prognostic accuracy of computed tomography findings for patients with laryngeal cancer undergoing laryngectomy. J Clin Oncol 28(14):2318–2322PubMedCrossRefGoogle Scholar
  21. 21.
    Becker M (2000) Neoplastic invasion of laryngeal cartilage: radiologic diagnosis and therapeutic implications. Eur J Radiol 33(3):216–229PubMedCrossRefGoogle Scholar
  22. 22.
    Zbären P, Becker M, Läng H (1996) Pretherapeutic staging of laryngeal carcinoma. Clinical findings, computed tomography, and magnetic resonance imaging compared with histopathology. Cancer 77(7):1263–1273PubMedCrossRefGoogle Scholar
  23. 23.
    Banko B, Dukić V, Milovanović J, Kovač JD, Artiko V, Maksimović R (2011) Diagnostic significance of magnetic resonance imaging in preoperative evaluation of patients with laryngeal tumors. Eur Arch Otorhinolaryngol 268(11):1617–1623PubMedCrossRefGoogle Scholar
  24. 24.
    Kinshuck AJ, Goodyear PW, Lancaster J, Roland NJ, Jackson S, Hanlon R, Lewis-Jones H, Sheard J, Jones TM (2012) Accuracy of magnetic resonance imaging in diagnosing thyroid cartilage and thyroid gland invasion by squamous cell carcinoma in laryngectomy patients. J Laryngol Otol 126(3):302–306PubMedCrossRefGoogle Scholar
  25. 25.
    Yeager VL, Archer CR (1982) Anatomical routes for cancer invasion of laryngeal cartilages. Laryngoscope 92(4):449–452PubMedCrossRefGoogle Scholar
  26. 26.
    Hartl DM, Landry G, Hans S, Marandas P, Brasnu DF (2010) Organ preservation surgery for laryngeal squamous cell carcinoma: low incidence of thyroid cartilage invasion. Laryngoscope 120(6):1173–1176PubMedGoogle Scholar
  27. 27.
    Rifai M, Khattab H (2000) Anterior commissure carcinoma: I—histopathologic study. Am J Otolaryngol 21(5):294–297PubMedCrossRefGoogle Scholar
  28. 28.
    Bagatella F, Bignardi L (1981) Morphological study of the laryngeal anterior commissure with regard to the spread of cancer. Acta Otolaryngol 92(1–2):167–171PubMedCrossRefGoogle Scholar
  29. 29.
    Pressman JJ (1956) Submucosal compartmentation of the larynx. Ann Otol Rhinol Laryngol 65(3):766–771PubMedCrossRefGoogle Scholar
  30. 30.
    Kirchner JA (1989) What have whole organ sections contributed to the treatment of laryngeal cancer? Ann Otol Rhinol Laryngol 98(9):661–667PubMedCrossRefGoogle Scholar
  31. 31.
    Wiernik G, Millard PR, Haybittle JL (1991) The predictive value of histological classification into degrees of differentiation of squamous cell carcinoma of the larynx and hypopharynx compared with the survival of patients. Histopathology 19(5):411–417PubMedCrossRefGoogle Scholar
  32. 32.
    Pera E, Moreno A, Galindo L (1986) Prognostic factors in laryngeal carcinoma. A multifactorial study of 416 cases. Cancer 58(4):928–934PubMedCrossRefGoogle Scholar
  33. 33.
    Hirvikoski P, Virtaniemi J, Kumpulainen E, Johansson R, Kosma VM (2002) Supraglottic and glottic carcinomas. Clinically and biologically distinct entities? Eur J Cancer 38(13):1717–1723PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Murat Ulusan
    • 1
  • Selin Unsaler
    • 1
  • Bora Basaran
    • 1
    Email author
  • Dilek Yılmazbayhan
    • 2
  • Ismet Aslan
    • 1
  1. 1.Department of Otolaryngology, Faculty of MedicineIstanbul UniversityFatih/CapaTurkey
  2. 2.Department of Pathology, Faculty of MedicineIstanbul UniversityIstanbulTurkey

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