Martin Alexios, Jäckel Martin C, Christiansen Hans, Mahmoodzada Mary, Kron Martina, Steiner Wolfgang
Department of Otorhinolaryngology-Head and Neck Surgery, University of Göttingen, Göttingen, Germany.
Laryngoscope. 2008 Mar;118(3):398-402. doi: 10.1097/MLG.0b013e31815aeda3.
To assess the feasibility of transoral laser microsurgery (TLM) in the treatment of hypopharyngeal cancer, with a special focus on piriform sinus carcinomas, and to report the oncologic and functional outcomes.
Prospective case-series study at a single institute, an academic tertiary referral center.
A total of 172 patients with previously untreated squamous cell carcinoma of the hypopharynx were eligible for this study (1986-2003). The piriform sinus was the most common localization (n = 150). Patients with simultaneous second primaries, distant metastases, or N3 neck disease and cancers of the category pT4b were excluded. Fifteen percent of the patients had stages I and II (according to guidelines from the Union Internationale Contre le Cancer 2002/American Joint Commission on Cancer, 2002), and 85% had stages III and IVa. The median follow-up period was 45 months. All patients (n = 172) were treated by TLM, mainly by selective neck dissection (93%) and/or postoperative radiotherapy (52%). Overall survival, recurrence-free survival, organ preservation, and local control were analyzed as end points. Rate of tracheotomies, postoperative complications, and swallowing function (feeding tube dependency) were also analyzed.
: Five-year Kaplan-Meier local control was 84% for pT1; 70% for pT2; 75% for pT3; and 57% for pT4a. Five-year Kaplan-Meier recurrence-free survival was 73% for stages I and II, 59% for stage III, and 47% for stage IVa. The whole group of 172 hypopharyngeal cancer patients was analyzed, with an additional special focus on the homogenous group of piriform sinus carcinomas (n = 150).
Our data support the conclusion that TLM is a valid option to standard radical surgery or standard conservation treatment. Oncologic and functional results compare favorably, while morbidity and complication rates tend to be lower.
评估经口激光显微手术（TLM）治疗下咽癌的可行性，尤其关注梨状窝癌，并报告肿瘤学及功能学结果。
在一所学术性三级转诊中心的单机构前瞻性病例系列研究。
共有172例先前未接受治疗的下咽鳞状细胞癌患者符合本研究条件（1986 - 2003年）。梨状窝是最常见的发病部位（n = 150）。同时患有第二原发癌、远处转移或N3颈部疾病以及pT4b类癌症的患者被排除。15%的患者为Ⅰ期和Ⅱ期（根据国际抗癌联盟2002年/美国癌症联合委员会2002年的指南），85%的患者为Ⅲ期和Ⅳa期。中位随访期为45个月。所有患者（n = 172）均接受TLM治疗，主要采用选择性颈清扫术（93%）和/或术后放疗（52%）。将总生存率、无复发生存率、器官保留率和局部控制率作为终点指标进行分析。还分析了气管切开率、术后并发症及吞咽功能（依赖饲管情况）。
pT1的5年Kaplan - Meier局部控制率为84%；pT2为70%；pT3为75%；pT4a为57%。Ⅰ期和Ⅱ期的5年Kaplan - Meier无复发生存率为73%，Ⅲ期为59%，Ⅳa期为47%。对172例下咽癌患者的整个队列进行了分析，尤其重点分析了梨状窝癌的同质组（n = 150）。
我们的数据支持以下结论，即TLM是标准根治性手术或标准保守治疗的有效替代方案。肿瘤学及功能学结果较好，而发病率和并发症发生率往往较低。
