{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T12:03:24Z","timestamp":1793189004493,"version":"4.5.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T00:00:00Z","timestamp":1643587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>About 20% of all glottic carcinomas involve the anterior commissure (AC), and AC involvement was deemed to be a risk factor of local recurrence and poor prognosis. Transoral robotic surgery (TORS) has been developed for a panoramic view of the AC and en-bloc resection of the tumor by multidirectional dissection with endo-wristed instruments. With satisfactory preliminary results, we would like to update the data with a bigger cohort and present the news on using TORS for salvage treatment of recurrence from irradiation failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From July 2010 to December 2019, 22 patients with early T1 and 2 stage primary (n = 11) or recurrent (n = 11) glottic cancer with AC involvement received TORS without adjuvant therapy. TORS exposure was found to be better than TLM by conventional laryngoscopy in diagnostic biopsy. Seven of the 22 patients had recurrent cancer from irradiation failure. The perioperative factors that may be associated with survival were retrospectively analyzed, and the 5-year overall survival (OS)\/disease-specific survival (DSS)\/recurrence-free survival (RFS)\/and organ preservation survival (OPS) rate were estimated by the Kaplan\u2013Meier Method. Their voice and swallowing functions were evaluated by questionnaires of Voice Handicap Index-10 (VHI-10) and Functional Outcome Swallowing Scale (FOSS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All 22 TORSs were completed smoothly. After a mean follow-up of 49 \u00b1 35.9 months, the Kaplan\u2013Meier method estimated 5-year OS\/DSS\/RFS\/OPS was 93.8%, 93.8%, 74.6%, and 86.3%, respectively. Our 11 patients with fresh cancer had 100% recurrence-free survival. Although the recurrent rate was higher in patients with history of RT, they could be rescued by further open laryngectomy without compromising the OS and DSS. Only one patient expired. The other 21 patients had satisfactory swallowing function with FOSS of 0.33 \u00b1 0.66. Five patients depended on tracheostomy, but the rest 17 patients had serviceable voice with VHI-10 of 18.41 \u00b1 11.29.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TORS could be used in the primary or salvage management of glottic cancer with AC involvement while TORS was confirmed to have better exposure to TLM. The RFS was good for patients with primary cancer. In patients having irradiation failure, TORS could also be a minimally invasive transoral approach before trying open surgery to preserve the organ.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.755400","type":"journal-article","created":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T07:23:26Z","timestamp":1643613806000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Transoral Robotic Surgery for Early-T Stage Glottic Cancer Involving the Anterior Commissure\u2014News and Update"],"prefix":"10.3389","volume":"12","author":[{"given":"Chen-Chi","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Jiun","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing-Jie","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Chih","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Li","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Jung","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-006-0138-3","article-title":"Primary Treatment of the Anterior Vocal Commissure Squamous Carcinoma","volume":"263","author":"Bradley","year":"2006","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1053\/ajot.2000.16159","article-title":"Anterior Commissure Carcinoma: I- Histopathologic Study","volume":"21","author":"Rifai","year":"2000","journal-title":"Am J Otolaryngol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20993","article-title":"Endoscopic Laser Surgery of Early Glottic Cancer: Involvement of the Anterior Commissure","volume":"31","author":"Rodel","year":"2009","journal-title":"Head Neck"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21528","article-title":"Evidence-Based Review of Treatment Options for Patients With Glottic Cancer","volume":"33","author":"Hartl","year":"2011","journal-title":"Head Neck"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/hed.1120","article-title":"Treatment of Early Stage Squamouscell Carcinoma of the Glottic Larynx: Endoscopic Surgery or Cricohyoidoepiglottopexy Versus Radiotherapy","volume":"23","author":"Bron","year":"2001","journal-title":"Head Neck"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20997","article-title":"Evaluation of Treatment Results With Regard to Initial Anterior Commissure Involvement in Early Glottic Carcinoma Treated by External Partial Surgery or Transoral Laser Microresection","volume":"31","author":"Sachse","year":"2009","journal-title":"Head Neck"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-009-1028-2","article-title":"Current Trends in Initial Management of Laryngeal Cancer: The Declining Use of Open Surgery","volume":"266","author":"Silver","year":"2009","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200408000-00031","article-title":"Impact of Anterior Commissure Involvement on Local Control of Early Glottic Carcinoma Treated by Laser Microresection","volume":"114","author":"Steiner","year":"2004","journal-title":"Laryngoscope"},{"key":"B9","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1177\/000348940111000102","article-title":"Local Recurrences Following Transoral Laser Surgery for Early Glottic Carcinoma: Frequency, Management, and Outcome","volume":"110","author":"Eckel","year":"2001","journal-title":"Ann Otol RhinolLaryngol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2003.07.002","article-title":"Carbon Dioxide Laser Salvage Surgery After Radiotherapy Failure in T1 and T2 Glottic Carcinoma","volume":"130","author":"Puxeddu","year":"2004","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2005.10.004","article-title":"Transoral Robotic Surgery (TORS): Glottic Microsurgery in a Canine Model","volume":"20","author":"O\u2019Malley","year":"2006","journal-title":"J Voice"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2008.0320","article-title":"Transoral Robotic Surgery (TORS) in Laryngeal and Hypopharyngeal Cancer","volume":"19","author":"Park","year":"2009","journal-title":"J\u00a0Laparoendosc Adv Surg Tech A"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2010.0350","article-title":"Transoral Robotic Surgery of the Vocal Cord","volume":"21","author":"Blanco","year":"2011","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"B14","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1177\/000348941212100801","article-title":"Transoral Robotic Cordectomy for Early Glottis Carcinoma","volume":"121","author":"Kayhan","year":"2012","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.anl.2018.08.015","article-title":"Oncological Outcomes of Early Glottis Carcinoma Treated With Transoral Robotic Surgery","volume":"46","author":"Kayhan","year":"2019","journal-title":"Auris Nasus Larynx"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23994","article-title":"Transoral Robotic Surgery for the Treatment of T1-T2 Carcinoma of the Larynx: Preliminary Study","volume":"123","author":"Lallemant","year":"2013","journal-title":"Laryngoscope"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24354","article-title":"Transoral Robotic Sur-Gery for Early Glottic Carcinoma Involving Anterior Commissure: Preliminary Reports","volume":"38","author":"Wang","year":"2016","journal-title":"Head Neck"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s11701-012-0349-0","article-title":"Transoral Robotic Supracricoid Partial Laryngectomy With Cartilaginous Framework Preservation","volume":"6","author":"Vural","year":"2012","journal-title":"J Robot Surg"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200409000-00009","article-title":"Development and Validation of the Voice Handicap Index-10","volume":"114","author":"Rosen","year":"2004","journal-title":"Laryngoscope"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1159\/000016941","article-title":"A Functional Outcome Swallowing Scale for Staging Oropharyngeal Dysphagia","volume":"17","author":"Salassa","year":"1999","journal-title":"Dig Dis"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s004050050228","article-title":"Endoscopic Cordectomy. A Proposal for a Classification by the Working Committee, European Laryngological Society","volume":"257","author":"Remacle","year":"2000","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1007\/s00405-007-0279-z","article-title":"Proposal for Revision of the European Laryngological Society Classification of Endoscopic Cordectomies","volume":"264","author":"Remacle","year":"2007","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3390\/cancers11091234","article-title":"Involvement of the Anterior Commissure in Early Glottic Cancer (Tis-T2): A Review of the Literature","volume":"11","author":"Hendriksma","year":"2019","journal-title":"Cancers (Basel)"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28395","article-title":"The Prognostic Value of Anterior Commissure Involvement in T1 Glottic Cancer: A Systematic Review and Meta-Analysis","volume":"130","author":"Tulli","year":"2020","journal-title":"Laryngoscope"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1007\/s10103-018-2695-2","article-title":"Efficacy of Laser Surgery Versus Radiotherapy for Treatment of Glottic Carcinoma: A Systematic Review and Meta-Analysis","volume":"34","author":"Ding","year":"2019","journal-title":"Lasers Med Sci"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-199010000-00014","article-title":"Endoscopic Laser Surgery for Early Glottic Carcinoma: A Clinical and Experimental Study","volume":"100","author":"Wolfensberger","year":"1990","journal-title":"Laryngoscope"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0000000000000240","article-title":"Reasonable Limits for Transoral Laser Microsurgery in Laryngeal Cancer","volume":"24","author":"Peretti","year":"2016","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1177\/000348940010900409","article-title":"Endolaryngeal Microsurgery at the Anterior Glottal Commissure: Controversies and Observations","volume":"109","author":"Desloge","year":"2000","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25757","article-title":"Early Glottic Cancer Involving the Anterior Commissure Treated by Transoral Laser Cordectomy","volume":"126","author":"Hoffmann","year":"2016","journal-title":"Laryngoscope"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215116010021","article-title":"Transoral Laser Resection of Glottic Carcinoma: What is the Significance of Anterior Commissure Involvement","volume":"131","author":"Stephenson","year":"2017","journal-title":"J Laryngol Otol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1177\/000348940311201014","article-title":"Radiotherapy of Early-Stage Glottic Cancer: Analysis of Factors Affecting Prognosis","volume":"112","author":"Chen","year":"2003","journal-title":"Ann OtolRhinolLaryngol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1177\/000348940311201014","article-title":"Transoral Carbon Dioxide Laser Microsurgery for Recurrent Glottic Carcinoma After Radiotherapy","volume":"26","author":"Steiner","year":"2004","journal-title":"Head Neck"},{"key":"B33","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1002\/hed.20502","article-title":"Histologic Characteristics and Tumor Spread of Recurrent Glottis Carcinoma: Analysis on Whole-Organ Sections and Comparison With Tumor Spread of Primary Glottic Carcinomas","volume":"29","author":"Zbaren","year":"2007","journal-title":"Head Neck"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198404000-00012","article-title":"Excisional Biopsy in the Selective Management of T1 Glottic Cancer: A Three-Year Follow-Up Study","volume":"94","author":"Blakeslee","year":"1984","journal-title":"Laryngoscope"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1177\/019459989110400611","article-title":"Laser Cordectomy for T1 Glottic Carcinoma: A 10-Year Experience and Videostroboscopic Findings","volume":"104","author":"Casiano","year":"1991","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1017\/s0022215100129421","article-title":"CO2-Laser Therapy for Carcinoma of the Larynx","volume":"109","author":"Outzen","year":"1995","journal-title":"J\u00a0Laryngol Otol"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0347(200008)22:5<520::aid-hed13>3.0.co;2-k","article-title":"Endoscopic Laser Surgery in the Treatment of Radiation Failure of Early Laryngeal Carcinoma","volume":"22","author":"Quer","year":"2000","journal-title":"Head Neck"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0347(200103)23:3<177::aid-hed1015>3.0.co;2-8","article-title":"CO2-Laser Treatment of Recurrent Glottic Carcinoma","volume":"23","author":"de Gier","year":"2001","journal-title":"Head Neck"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198406000-00022","article-title":"CO2 Laser in Malignant Lesions of the Larynx","volume":"94","author":"Annyas","year":"1984","journal-title":"Laryngoscope"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-014-3056-9","article-title":"Cost Comparison of Open Approach, Transoral Laser Microsurgery and Transoral Robotic Surgery for Partial and Total Laryngectomies","author":"Dombr\u00e9e","year":"2014","journal-title":"Eur Arch Otorhinolaryngo"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1671e80","DOI":"10.1007\/s00405-018-4986-4","article-title":"Supracricoid Partial Laryngectomy for Radiorecurrent Laryngeal Cancer:a Systematic Review of the Literature and Meta-Analysis","volume":"275","author":"De Virgilio","year":"2018","journal-title":"Eur Arch Oto-Rhino-Laryngol"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27959","article-title":"Salvage Open Partial Horizontal Laryngectomy After Failed Radiotherapy: A Multicentric Study","volume":"130","author":"Bertolin","year":"2020","journal-title":"Laryngoscope"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20415","article-title":"Conservation Laryngeal Surgery Versus Total Laryngectomy for Radiation Failure in Laryngeal Cancer","volume":"28","author":"Holsinger","year":"2006","journal-title":"Head Neck"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2019.00408","article-title":"Limitations and Opportunities in Open Laryngeal Organ Preservation Surgery: Current Role of OPHLs","volume":"22","author":"Succo","year":"2019","journal-title":"Front Oncol"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-015-3822-3","article-title":"Functional Outcomes After Supracricoid Laryngectomy: What do We Not Know and What do We Need to Know","volume":"273","author":"Schindler","year":"2016","journal-title":"Eur Arch Otorhinolaryngol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.755400\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T07:23:28Z","timestamp":1643613808000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.755400\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,31]]},"references-count":45,"alternative-id":["10.3389\/fonc.2022.755400"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2022.755400","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,31]]},"article-number":"755400"}}