Recurrence after modified type III cordectomy for glottic cancer: Predisposing factors and management

BACKGROUND: Modified type III cordectomy provides satisfactory oncological and voice outcomes in selected patients with early glottic cancer. However, the factors associated with local recurrence following this procedure remain unclear. This study investigated the predictors of local recurrence following modified type III cordectomy and evaluated subsequent salvage management. METHODS: Patients who underwent modified type III cordectomy for glottic cancer at a tertiary referral center between 2006 and 2022 were retrospectively reviewed. Clinicopathological factors, including tumor stage, pathology, morphology, involved subsites, surgical margin status, and history of biopsy or surgery, were analyzed for their association with local recurrence. Salvage treatment outcomes were evaluated. RESULTS: A total of 58 patients were included in this study. The cohort was predominantly male (95%) with a median age of 61 years. The mean follow-up period was 78 months. Local recurrence occurred in 13 patients (22%) at a mean interval of 22 months after surgery. Tumor pathology and morphology were significantly associated with recurrence. Spindle cell carcinoma (SpCC) and endophytic tumors were associated with a substantially higher risk of recurrence than conventional squamous cell carcinoma and exophytic lesions. All recurrent tumors were treated with salvage transoral laser microsurgery (TLM), and six patients received postoperative radiotherapy. Successful salvage with laryngeal preservation was achieved in 11 (85%) patients. CONCLUSION: Endophytic morphology and SpCC pathology are significant predictors of local recurrence after modified type III cordectomy. Careful postoperative surveillance is particularly important in these patients. Primary treatment with TLM preserves multiple salvage treatment options and enables high rates of laryngeal preservation in patients with recurrent disease.