Yao Mike, Roebuck Jeremy C, Holsinger F Christopher, Myers Jeffery N
Department of Otolaryngology, University of Illinois, Chicago, IL 60657, USA.
Am J Otolaryngol. 2005 Nov-Dec;26(6):388-92. doi: 10.1016/j.amjoto.2005.05.002.
To evaluate the rate of occult metastases detected with elective neck dissection during salvage laryngectomy for radiation failures.
Retrospective review of 63 patients failing radiation therapy treated with salvage surgery between 1970 and 1999. Charts were reviewed for tumor stage, neck treatment, complications, surgical time, and survival. Median follow-up for patients with glottic and supraglottic cancers was 7.8 and 4.5 years, respectively.
Thirty-one of 41 glottic cancer patients received elective neck dissections. Three (10%) of 31 had occult metastases. Recurrent staged rT3 and greater tumors showed a 20% rate of occult metastases. No survival advantage was noted between patients treated with elective neck dissection and those followed expectantly (P = .87). Cartilage invasion and perineural invasion in the larynx were associated with a higher risk of occult metastases (P < .05). Ten of 22 supraglottic cancer patients received elective neck dissections. Two (20%) of 10 had occult metastases, and a statistically significant survival advantage was not noted (P = .49).
We recommend bilateral neck dissection at the time of laryngectomy for recurrent staged rT3/4 tumors and all patients with recurrent supraglottic cancers because of the higher rate of occult metastases.
评估在挽救性喉切除术治疗放疗失败患者时，选择性颈清扫术检测到隐匿性转移的发生率。
回顾性分析1970年至1999年间接受挽救性手术治疗的63例放疗失败患者。查阅病历以获取肿瘤分期、颈部治疗、并发症、手术时间和生存率等信息。声门癌和声门上癌患者的中位随访时间分别为7.8年和4.5年。
41例声门癌患者中有31例接受了选择性颈清扫术。31例中有3例（10%）存在隐匿性转移。复发分期为rT3及以上的肿瘤隐匿性转移发生率为20%。接受选择性颈清扫术的患者与期待观察的患者之间未观察到生存优势（P = 0.87）。喉软骨侵犯和神经周围侵犯与隐匿性转移风险较高相关（P < 0.05）。22例声门上癌患者中有10例接受了选择性颈清扫术。10例中有2例（20%）存在隐匿性转移，且未观察到统计学上显著的生存优势（P = 0.49）。
由于隐匿性转移发生率较高，我们建议对复发分期为rT3/4的肿瘤患者以及所有复发性声门上癌患者在喉切除时行双侧颈清扫术。
