Transoral coblation surgery – a viable option for early laryngeal cancers involving the anterior commissure?
Reviewed by Christopher Burgess

Transoral laser microsurgery is widely considered to represent the ideal treatment modality for early (T1a) laryngeal cancers. With disease involving the anterior commissure however, radiotherapy is often advocated on account of perceived superior voice and airway outcomes, plus potential difficulty with surgical access to the very front of the larynx transorally. One alternative to transoral laser surgery to treat laryngeal lesions in patients with restricted laryngeal access is plasma radiofrequency (coblation) surgery, as the flexible coblation wand permits access to areas that cannot be targeted with a line-of-sight laser. This paper reports the outcomes of 65 patients with T1-2 laryngeal cancers involving the anterior commissure treated with coblation over a 12-year period. Five-year overall and disease-specific survival rates were 95.2% and 96.7% respectively. Fourteen patients (21.5%) experienced recurrence, 9 of whom required a salvage total laryngectomy. The 5-year laryngeal preservation rate was 83.5%. This paper does not report voice or swallowing outcomes, which the authors acknowledge is a limitation. Nevertheless the reported recurrence and laryngeal preservation rates seem reasonably comparable to radiotherapy. Combined with the high OS/DSS reported, these findings suggest that transoral coblation-assisted excision may be considered as a treatment option in a select minority of patients with early laryngeal cancers involving the anterior commissure that are not amenable to laser resection, provided further studies confirm acceptable functional outcomes.

Oncologic outcomes of transoral endoscopic plasma radiofrequency surgery for early-stage glottic laryngeal cancer with anterior commissure involvement. 
Chen C, Liu C, Li J, et al.
AM J OTOLARYNGOL
2026;47(4):104821.