Schramm V L, Imola M J
Center for Craniofacial-Skull Base Surgery, Denver, Colorado, USA.
Laryngoscope. 2001 Sep;111(9):1533-44. doi: 10.1097/00005537-200109000-00009.
The objective of this study was to evaluate the oncological outcome and complication rate following surgical treatment of nasopharyngeal salivary gland malignancy.
Retrospective case review at tertiary care skull base center.
Pertinent medical records were reviewed from 23 patients presenting with minor salivary gland malignancy. Clinical presentation, prior treatment, histological type and grade, clinical stage, details of surgical treatment, and postoperative adjuvant radiation therapy were studied. Survival and recurrence data were analyzed using the Kaplan-Meier and Cox proportional hazards methods.
Histological types included 11 adenoid cystic carcinomas, 8 mucoepidermoid carcinomas, and 4 cases of adenocarcinoma not otherwise specified. All patients underwent primary surgical resection, and the lateral infratemporal middle fossa approach was used in 20 patients. Prior radiation therapy had been administered in 6 patients who presented for treatment of recurrent disease, and the remaining 17 patients underwent planned postoperative radiation therapy. Elective neck dissection was undertaken in 15 patients, and occult neck disease was present in 47%. Disease specific survival was 67% at 5 years and 48% at 10 years. High-grade tumors had a significantly poorer outcome (P =.035) with a relative risk of 4.6 compared with low-grade disease. Local control was seen to be 77% at 5 years.
Planned combined surgery and radiation therapy achieves survival outcomes and recurrence rates in nasopharyngeal salivary gland malignancy comparable to results reported using the same treatment for minor salivary gland tumors cancer originating elsewhere in the head and neck. Because of the high rate of occult neck metastases, we recommend elective neck dissection as part of the surgical treatment with this disease entity. The lateral infratemporal middle fossa approach provides safe and adequate access to resect the vast majority of these tumors with acceptable complication rates. A reliable form of vascularized reconstruction is necessary to prevent serious postoperative complications, and we currently prefer the gastro-omental free flap.
本研究的目的是评估鼻咽部涎腺恶性肿瘤手术治疗后的肿瘤学结局和并发症发生率。
在三级医疗颅底中心进行回顾性病例分析。
回顾了23例小涎腺恶性肿瘤患者的相关病历。研究了临床表现、既往治疗、组织学类型和分级、临床分期、手术治疗细节以及术后辅助放疗情况。使用Kaplan-Meier法和Cox比例风险法分析生存和复发数据。
组织学类型包括11例腺样囊性癌、8例黏液表皮样癌和4例未另作特殊说明的腺癌。所有患者均接受了初次手术切除，20例患者采用了外侧颞下中颅窝入路。6例因复发性疾病就诊的患者曾接受过放疗，其余17例患者接受了计划性术后放疗。15例患者进行了选择性颈清扫，47%的患者存在隐匿性颈部疾病。5年疾病特异性生存率为67%，10年为48%。高级别肿瘤的结局明显较差（P = 0.035），与低级别疾病相比相对风险为4.6。5年局部控制率为77%。
计划性联合手术和放疗在鼻咽部涎腺恶性肿瘤中取得的生存结局和复发率，与对头颈部其他部位起源的小涎腺肿瘤采用相同治疗方法所报告的结果相当。由于隐匿性颈部转移率高，我们建议将选择性颈清扫作为该疾病实体手术治疗的一部分。外侧颞下中颅窝入路能安全、充分地切除绝大多数此类肿瘤，并发症发生率可接受。为预防严重的术后并发症，可靠的带血管重建形式是必要的，我们目前更倾向于使用游离胃网膜瓣。
