Steiner W, Ambrosch P, Hess C F, Kron M
Departments of Otorhinolaryngology, Head and Neck Surgery, University of Goettingen, Germany.
Otolaryngol Head Neck Surg. 2001 Jan;124(1):58-67. doi: 10.1067/mhn.2001.111597.
To determine the effectiveness of organ-preserving CO2 laser microsurgery for the treatment of piriform sinus carcinoma.
A retrospective review of 129 previously untreated patients undergoing CO2 laser microsurgery for the treatment of squamous cell carcinomas of the piriform sinus from 1981 to December 1996 was undertaken. The intention was complete tumor removal by preserving functionally important structures of the larynx. Distribution of tumors (Union Internationale Contre le Cancer/American Joint Committee on Cancer, 1992) was 24 cases with pT1, 74 with pT2, 17 with pT3, and 14 with pT4 disease. Node status was positive in 68% of patients. Seventy-five percent of patients had stage III or IV disease. Forty-two percent of the patients were treated solely with surgery, and 58% had surgery and postoperative radiotherapy. The median follow-up interval was 44 months.
Eighty-seven percent of patients were controlled locally. Neck recurrences occurred in 14.0% of patients, metachronous distant metastases with locoregional control in 6.2%, and second primary tumors in 18.6%. Twenty percent of patients died of TNM-related deaths. The 5-year overall Kaplan-Meier survival rate was 71% for stages I and II and 47% for stages III and IV disease; the 5-year recurrence-free survival rates were 95% and 69%, respectively.
A comparatively low local recurrence rate, a high recurrence-free survival rate, and the avoidance of laryngectomy favor function-preserving surgery of piriform sinus carcinomas.
确定保留器官的二氧化碳激光显微手术治疗梨状窝癌的有效性。
对1981年至1996年12月期间129例未经治疗、接受二氧化碳激光显微手术治疗梨状窝鳞状细胞癌的患者进行回顾性研究。目的是通过保留喉的功能重要结构来完全切除肿瘤。肿瘤分布（国际抗癌联盟/美国癌症联合委员会，1992年）为：pT1期24例，pT2期74例，pT3期17例，pT4期14例。68%的患者有淋巴结转移。75%的患者为Ⅲ期或Ⅳ期疾病。42%的患者仅接受手术治疗，58%的患者接受手术及术后放疗。中位随访时间为44个月。
87%的患者局部得到控制。14.0%的患者出现颈部复发，6.2%的患者出现异时性远处转移且局部得到控制，18.6%的患者出现第二原发肿瘤。20%的患者死于TNM相关死亡。Ⅰ期和Ⅱ期患者的5年总体Kaplan-Meier生存率为71%，Ⅲ期和Ⅳ期疾病患者为47%；5年无复发生存率分别为95%和69%。
梨状窝癌保留功能手术具有相对较低的局部复发率、较高的无复发生存率以及避免喉切除术的优点。
