About Prof. Zhou Liang
Prof. Zhou Liang is a senior laryngologist at the Eye & ENT Hospital of Fudan University, specialising in laryngeal cancer surgery, voice restoration, and minimally invasive endoscopic laryngeal procedures. He is a national authority on laryngeal function preservation and head and neck oncology in China. His research programme spanning 500 laryngeal cancer patients established the evidence base for the Chinese Guidelines on Laryngeal Cancer Function-Preserving Surgery (2025 Edition), which codified his three-tier surgical strategy as the national standard. His innovations include a 2.9 mm flexible laryngoscope, a 3D-printed surgical planning system (three national patents, National Science and Technology Progress Award Second Class 2024), and the "Three Principles of Laryngeal Function Preservation" — precise resection, structural reconstruction, and functional rehabilitation — now adopted as the field's guiding framework.
Case Overview
Mr. Fang (pseudonym), a 58-year-old man and professional teacher, presented to Prof. Zhou's clinic with a three-month history of progressive hoarseness. Flexible laryngoscopy identified a right vocal cord lesion; NBI endoscopy delineated the tumour boundary with high precision. Biopsy confirmed moderately differentiated squamous cell carcinoma. CT of the neck and chest confirmed a right glottic tumour confined to the vocal cord with no subglottic extension, no cartilage invasion, and no regional lymphadenopathy — staged T2N0M0. Mr. Fang's priority was unambiguous: he needed to preserve his voice. Prof. Zhou recommended transoral laser microsurgery (TLM) with NBI-guided margin delineation and 3D-printed laryngeal model-assisted surgical planning. Operative time was 52 minutes; no tracheotomy was required. Intraoperative frozen section confirmed clear margins; final pathology confirmed R0 resection. At one-year follow-up, local control was maintained; voice handicap index (VHI-10) had improved from 36 to 8; acoustic analysis confirmed near-normal vocal function. Mr. Fang reflected: "My voice is my livelihood. When they told me it was cancer, my first thought was that I would never teach again. Prof. Zhou's team told me they could remove the tumour and preserve my voice — and they did. I am back in the classroom. I am grateful beyond words."
Diagnostic Workup
Flexible laryngoscopy: right vocal cord lesion with irregular surface; normal cord mobility bilaterally. NBI endoscopy: intrapapillary capillary loop pattern consistent with invasive carcinoma; tumour boundary delineated to within 1 mm. Biopsy: moderately differentiated squamous cell carcinoma, right glottis. CT neck and chest: right glottic tumour confined to vocal cord; no subglottic extension; no thyroid or cricoid cartilage invasion; no cervical lymphadenopathy; no distant metastasis. Staging: T2N0M0 (AJCC 8th edition). 3D-printed laryngeal model: constructed from CT data; tumour resection margins and laser trajectory planned preoperatively; operative time reduced by 40 minutes vs conventional planning. Multidisciplinary review — laryngology, head and neck oncology, radiation oncology, and speech-language pathology — confirmed TLM as the preferred approach over radiotherapy given tumour size, patient preference for voice preservation, and the availability of Prof. Zhou's NBI-guided technique.
Prof. Zhou's pre-operative assessment: T2N0M0 glottic carcinoma with normal cord mobility is an ideal TLM candidate. NBI delineates the tumour boundary with a precision that white-light endoscopy cannot match — the margin positive rate drops from 15% to under 3%. The 3D-printed model allows us to plan the laser trajectory before the patient is on the table. This patient will keep his voice.
Treatment Strategy and Course
Diagnosis: T2N0M0 moderately differentiated squamous cell carcinoma, right glottis — vocal cord mobility preserved; no cartilage invasion; function-preserving surgery appropriate.
Treatment principle: transoral laser microsurgery with NBI-guided margin delineation and 3D-printed surgical planning — complete oncological resection with preservation of laryngeal structure, voice, and airway.
- 3D-printed surgical planning: Laryngeal model constructed from CT data; tumour resection margins and laser trajectory planned preoperatively; operative time 52 minutes (vs 92 minutes conventional)
- TLM with NBI guidance: Suspension laryngoscopy; NBI endoscopy confirmed tumour boundaries; CO₂ laser resection with 3 mm margins; margin positive rate <3%; no tracheotomy required
- Intraoperative frozen section: All margins clear; no conversion to open surgery required
- Final pathology: Moderately differentiated SCC; R0 resection; all margins clear; pT2N0M0; no adjuvant therapy indicated
- Voice rehabilitation: Speech-language therapy commenced at 2 weeks; individualised vocal exercises; VHI-10 36 → 8 at 12 months; acoustic analysis confirmed near-normal fundamental frequency and jitter
- One-year follow-up: Local control maintained on laryngoscopy; no regional recurrence; no tracheostomy; patient returned to full-time teaching
Prof. Zhou's clinical reflection: R0 resection, local control at one year, VHI-10 from 36 to 8, back in the classroom — this is what function-preserving laryngeal surgery is designed to achieve. NBI made the margin safe. The 3D model made the planning precise. The speech therapy made the voice functional. Oncological radicality and functional preservation are not in conflict — with the right technique, they are the same operation.
Expert Commentary — Prof. Zhou Liang
1. The Three-Tier Surgical Strategy for Laryngeal Cancer
Prof. Zhou's function-preserving framework stratifies surgical approach by tumour stage and location. For early glottic cancer (T1–T2), transoral laser microsurgery or plasma radiofrequency ablation achieves local control rates of 95% with voice preservation in 90% of patients — without tracheotomy or open neck incision. For intermediate and advanced disease (T3–T4), partial laryngectomy with functional reconstruction — vertical hemilaryngectomy with pectoralis major flap, or supracricoid partial laryngectomy (SCPL) with tracheoesophageal voice prosthesis — achieves R0 resection while reconstructing phonation and swallowing. In his 500-patient series, the function-preserving group achieved a 5-year survival rate of 82% (vs 80% for total laryngectomy; P=NS) with voice preservation in 75% of patients (vs 10% for total laryngectomy). Tracheostomy rate fell from 100% to 20%; pulmonary infection rate from 25% to 8%.
2. NBI Endoscopy and 3D-Printed Surgical Planning
Accurate tumour margin delineation is the central technical challenge in laryngeal cancer surgery: a positive margin mandates re-resection or adjuvant radiotherapy, with significant functional consequences. Narrowband imaging (NBI) endoscopy identifies the intrapapillary capillary loop patterns that distinguish invasive carcinoma from normal mucosa with a precision white-light endoscopy cannot match, reducing the margin positive rate from 15% to under 3% in Prof. Zhou's series. The 3D-printed laryngeal model — constructed from the patient's CT data — allows preoperative simulation of the resection trajectory, identification of anatomical variants, and optimisation of laser angles before the patient is on the table, reducing mean operative time by 40 minutes and intraoperative blood loss by 50 mL. The system has been granted three national invention patents and reduces equipment cost by 50% compared with imported alternatives.
3. Voice Rehabilitation and the Functional Recovery Window
Surgical cure without functional recovery is an incomplete outcome in laryngeal cancer. Prof. Zhou's perioperative rehabilitation protocol addresses both phonation and swallowing: intraoperative preservation of the superior laryngeal nerve and postcricoid mucosa protects swallowing function, reducing aspiration from 30% to 10%; structured postoperative speech-language therapy — commenced at two weeks and individualised to the patient's residual laryngeal anatomy — achieves voice intelligibility above 80% in total laryngectomy patients using oesophageal voice or electronic larynx. Prof. Zhou's identification of the "critical mucosal repair window" (postoperative weeks 3–6) — the period of maximal epithelial regeneration — informs the timing of voice therapy initiation and the intensity of the rehabilitation programme, maximising functional recovery within the window of greatest neuroplasticity.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Mr. Fang throughout his pathway at the Eye & ENT Hospital of Fudan University, providing priority consultation coordination with Prof. Zhou's laryngology and head and neck oncology team, bilingual interpretation across all consultations and multidisciplinary tumour board review, bilingual explanation of the T2N0M0 staging, TLM plan, NBI margin delineation, and voice rehabilitation protocol, coordination of laryngoscopy, NBI endoscopy, biopsy, CT, and 3D model construction with bilingual results communication, bilingual surgical consent, and voice rehabilitation scheduling.
For international patients with laryngeal cancer, voice disorders, or head and neck tumours — particularly those seeking function-preserving approaches that maintain voice and swallowing — Prof. Zhou Liang's team offers access to one of China's most advanced laryngological oncology programmes. CMCS ensures that expertise is accessible, in the patient's language, with every step coordinated clearly.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
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