Clark Jonathan R, de Almeida John, Gilbert Ralph, Irish Jonathan, Brown Dale, Neligan Peter, Gullane Patrick J
Department of Head and Neck Surgical Oncology, Princess Margaret Hospital, Wharton Head and Neck Centre, 610 University Avenue, Toronto, ON M5G 2M9.
Head Neck. 2006 Aug;28(8):671-7. doi: 10.1002/hed.20428.
Surgery for squamous cell carcinoma (SCC) arising or extending to the hypopharynx is generally reserved for advanced disease or salvage. The prognosis of patients requiring pharyngectomy is poor, and the perioperative morbidity is significant. The aim of the present study is to describe the disease-related and treatment-related outcomes of patients undergoing primary and salvage pharyngectomy for cancer of the hypopharynx and larynx over a 10-year period from a single institution.
We retrospectively reviewed 138 partial and circumferential pharyngectomies performed at a tertiary referral center between 1992 and 2002. There were 31 females and 107 males. The median age was 62 years (range, 27-81 years), and mean follow-up was 3.6 years. Salvage pharyngectomy for radiation failure was performed in 72 patients (52%), and in 66 patients (48%) pharyngectomy was performed as the primary treatment.
The 5-year overall survival rate after salvage pharyngectomy was 31% and after primary pharyngectomy was 38%. The 5-year disease-specific survival (DSS) for salvage was 40% and after primary surgery was 45%. The 5-year local and regional control rates for salvage pharyngectomy were 71% and 70%, respectively, and for primary pharyngectomy were 79% and 67%, respectively. The perioperative mortality rate was 3.6%, and the combined morbidity rate was 70%. Postoperative hypocalcemia developed in 44% of patients, a pharyngocutaneous fistula developed in 31% of patients, and the long-term stricture rate was 15%. Variables adversely affecting DSS on univariate analysis were nodal metastases (p = .044), extracapsular spread (ECS) (p = .006), poorly differentiated tumors (p = .015), lymphovascular invasion (p = .042), and positive tumor margins (p = .026). ECS (p = .023) was the only independent prognostic variable on multivariable analysis; however, there was a trend toward significance for nodal metastases (p = .064) and tumor differentiation (p = .079).
This study demonstrates that both salvage pharyngectomy and primary surgery for advanced disease are viable options with high locoregional control. However, this represents a high-risk group in terms of both operative morbidity and survival. Patients with nodal metastases, ECS, and poorly differentiated tumors are likely to succumb to their disease and should be selected for adjuvant therapy when possible.
下咽鳞状细胞癌（SCC）的手术治疗通常适用于晚期疾病或挽救性治疗。需要进行咽切除术的患者预后较差，围手术期发病率较高。本研究的目的是描述在一家机构进行的为期10年的下咽癌和喉癌初次及挽救性咽切除术患者的疾病相关和治疗相关结果。
我们回顾性分析了1992年至2002年在一家三级转诊中心进行的138例部分和全周咽切除术。其中女性31例，男性107例。中位年龄为62岁（范围27 - 81岁），平均随访时间为3.6年。72例患者（52%）因放疗失败进行挽救性咽切除术，66例患者（48%）进行初次咽切除术作为主要治疗。
挽救性咽切除术后5年总生存率为31%，初次咽切除术后为38%。挽救性手术的5年疾病特异性生存率（DSS）为40%，初次手术后为45%。挽救性咽切除术的5年局部和区域控制率分别为71%和70%，初次咽切除术分别为79%和67%。围手术期死亡率为3.6%，合并发病率为70%。44%的患者术后发生低钙血症，31%的患者发生咽皮肤瘘，长期狭窄率为15%。单因素分析中对DSS有不利影响的变量包括淋巴结转移（p = 0.044）、包膜外扩散（ECS）（p = 0.006）、低分化肿瘤（p = 0.015）、淋巴管浸润（p = 0.042）和肿瘤切缘阳性（p = 0.026）。多因素分析中ECS（p = 0.023）是唯一的独立预后变量；然而，淋巴结转移（p = 0.064）和肿瘤分化（p = 0.079）有显著趋势。
本研究表明，挽救性咽切除术和晚期疾病的初次手术都是可行的选择，局部区域控制率较高。然而，就手术发病率和生存率而言，这是一个高危群体。有淋巴结转移、ECS和低分化肿瘤的患者可能死于疾病，应尽可能选择辅助治疗。
