[The comparison of preoperative examination, computed tomography and peroperative macroscopic inspection in the determination of anterior commissural involvement in laryngeal cancer].

OBJECTIVES In this study preoperative examination, computed tomography and the peroperative macroscopic examination of the specimen were compared in the determination of anterior commissural involvement in laryngeal cancer. PATIENTS AND METHODS Twenty-two male patients (mean age 59.6 ± 9.9 years; range 46 to 78 years) who underwent total laryngectomy for laryngeal cancer between January 2007 and May 2010 in our clinic were enrolled into this study. The anterior commissures were evaluated in all patients by preoperative examination, computed tomography and peroperative macroscopic examination of the specimens. For the preoperative evaluation, examination with a 70-degree rigid endoscope and microscopic examination under general anesthesia using suspension laryngoscopy were used. The tomographic sections of the neck and the comments were analyzed and the status of the anterior commissure was evaluated. After the removal of the laryngectomy sample, the larynx was vertically incised on its posterior aspect and anterior commissure was examined peroperatively. All the data obtained were statistically interpreted on the basis of the histopathological results of the anterior commissure. RESULTS According to the histopathological assessments, the rate of invasion of the anterior commissure by the tumor was determined to be 72.7%. In the preoperative examination, the anterior commissure was found to be invaded by the tumor in 56.3% of the patients. This ratio was 50% with neck computed tomography and 93.8% by the peroperative examination of the samples. CONCLUSION In laryngeal cancer, anterior commissure involvement is a very important factor in selecting the surgical technique and in predicting the behavior of the tumor. Preoperative examination and classical axial computed tomography have limited a role in the detection of the anterior commissural involvement. Computed tomography reconstructed by a highly experienced radiologist may be more helpful for us in the evaluation of the anterior commissure.