Ganly Ian, Patel Snehal, Matsuo Jeanette, Singh Bhuvanesh, Kraus Dennis, Boyle Jay, Wong Richard, Lee Nancy, Pfister David G, Shaha Ashok, Shah Jatin
Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Cancer. 2005 May 15;103(10):2073-81. doi: 10.1002/cncr.20974.
The objectives of the current study were to report the incidence of postoperative complications for salvage total laryngectomy (STL) compared with primary total laryngectomy (PTL) and to identify patient and tumor-related factors predictive of postoperative complications.
A sample of 183 patients who had received a total laryngectomy were identified from an existing database of 662 patients treated for squamous cell carcinoma of the larynx. PTL and STL were performed in 113 and 70 patients, respectively. Initial therapy in the patients who required salvage surgery included radiotherapy (RT) in 32 (46%) and chemoradiotherapy (CTRT) in 38 (54%). Postoperative complications were recorded for each group and categorized into local, swallowing, airway, and systemic complications. Postoperative complication rates for STL after RT and CTRT were compared with those after PTL by univariate analysis. Patient and tumor-related predictors of complications were identified by univariate and multivariate analyses.
The overall mortality rate was 0.5%. Forty percent of all patients developed a postoperative complication after total laryngectomy. Local complications, which were the most frequent, occurred in 52 (28%) patients. Pharyngocutaneous fistula occurred in 31 (17%) patients. Statistical analysis showed that there was a greater number of patients with local wound (45% vs. 25%, P = 0.02) and fistula complications (32% vs. 12%, P = 0.012) in the STL-CTRT group compared with the primary laryngectomy group. Multivariate analysis showed that primary CTRT was an independent predictor of local complications and pharyngocutaneous fistula.
Salvage laryngectomy was more frequently associated with postoperative complications after CTRT compared with PTL. Problems related to local wound healing, especially the development of pharyngocutaneous fistula, constituted the most common postoperative complication in these patients. Multivariate analysis showed that primary CTRT was an independent predictor of local wound complications and pharyngocutaneous fistula.
本研究的目的是报告挽救性全喉切除术（STL）与初次全喉切除术（PTL）相比术后并发症的发生率，并确定预测术后并发症的患者和肿瘤相关因素。
从一个现有数据库中识别出183例接受全喉切除术的患者，该数据库包含662例接受喉鳞状细胞癌治疗的患者。分别有113例和70例患者接受了PTL和STL。需要挽救性手术的患者的初始治疗包括32例（46%）接受放疗（RT）和38例（54%）接受放化疗（CTRT）。记录每组患者的术后并发症，并分为局部、吞咽、气道和全身并发症。通过单因素分析比较RT和CTRT后STL的术后并发症发生率与PTL后的发生率。通过单因素和多因素分析确定并发症的患者和肿瘤相关预测因素。
总死亡率为0.5%。所有患者中有40%在全喉切除术后出现术后并发症。局部并发症最为常见，发生在52例（28%）患者中。咽皮肤瘘发生在31例（17%）患者中。统计分析表明，与初次喉切除术组相比，STL-CTRT组局部伤口并发症（45%对25%，P = 0.02）和瘘管并发症（32%对12%，P = 0.012）的患者数量更多。多因素分析表明，初次CTRT是局部并发症和咽皮肤瘘的独立预测因素。
与PTL相比，挽救性喉切除术在CTRT后更常与术后并发症相关。与局部伤口愈合相关的问题，尤其是咽皮肤瘘的发生，是这些患者最常见的术后并发症。多因素分析表明，初次CTRT是局部伤口并发症和咽皮肤瘘的独立预测因素。
