Akduman Davut, Karaman Murat, Uslu Celil, Bilaç Omer, Türk Ozlem, Deniz Mahmut, Durmuş Ruhi
Department of Otolaryngology, Umraniye Training and Research Hospital, Istanbul, Turkey.
Kulak Burun Bogaz Ihtis Derg. 2010 Jan-Feb;20(1):25-32.
To make a contribution to the treatment modality of larynx cancer, we evaluated our surgical outcomes of the patients with larynx cancer and their quality of life in the postoperative period.
Forty-three patients (38 males, 5 females; mean age 57.6 years; range 34 to 84 years) with larynx cancer were included in this retrospective clinical study. Total laryngectomy/near total laryngectomy (TL/NTL) was performed in 29 patients, supracricoid laryngectomy in 13 patients and supraglottic laryngectomy in one patient. Neck dissection performed in 39 patients. Two patients had preoperative and eleven patients had postoperative radiotherapy (RT). The patients were evaluated with respect to age, sex, smoking, alcohol consumption, localization-differentiation-stage of the tumor, surgery and RT, postoperative complications and survival. QLQ-C30 and QLQ-H and N35 questionnaires were used and the results of 26 patients who were alive and filled in the questionnaires themselves were evaluated.
The most frequent postoperative complication was pharyngocutaneous fistula (41.3%), which occurred only in TL/NTL patients. Mean postoperative hospitalization time was 21.2 days. Laryngeal preservation, peristomal recurrence and locoregional recurrence rates were 64.3%, 6.9% and 9.3% respectively. Overall survival rate was 88.8%. Mean survival time was 62.4 months. In quality of life assessment, speech problem (p<0.01) and cough index (p<0.05) were significantly higher in TL/NTL group than SCL group (p<0.05). There were no significant difference in both groups with respect to RT (p>0.05).
Our surgical outcomes are compatible with the previous studies. Although the larynx preservation had a positive effect on the speech, it did not affect other quality of life parameters. In addition, having a permanent tracheostomy increased cough index markedly. We emphasize that multi-institutional prospective quality of life studies comparing different treatment methods for similar stage tumors are essential in defining the optimal management strategy in patients with larynx cancer.
为了对喉癌的治疗方式做出贡献，我们评估了喉癌患者的手术结果及其术后生活质量。
本回顾性临床研究纳入了43例喉癌患者（38例男性，5例女性；平均年龄57.6岁；范围34至84岁）。29例行全喉切除术/近全喉切除术（TL/NTL），13例行环状软骨上喉切除术，1例行声门上喉切除术。39例行颈部淋巴结清扫术。2例患者术前行放疗，11例患者术后行放疗（RT）。对患者的年龄、性别、吸烟、饮酒、肿瘤的定位-分化-分期、手术及放疗、术后并发症和生存率进行评估。使用QLQ-C30和QLQ-H及N35问卷，对26例存活且自行填写问卷的患者结果进行评估。
最常见的术后并发症是咽皮肤瘘（41.3%），仅发生在TL/NTL患者中。术后平均住院时间为21.2天。喉保留率、造口周围复发率和局部区域复发率分别为64.3%、6.9%和9.3%。总生存率为88.8%。平均生存时间为62.4个月。在生活质量评估中，TL/NTL组的言语问题（p<0.01）和咳嗽指数（p<0.05）显著高于环状软骨上喉切除术（SCL）组（p<0.05）。两组在放疗方面无显著差异（p>0.05）。
我们的手术结果与先前的研究一致。虽然喉保留对言语有积极影响，但不影响其他生活质量参数。此外，永久性气管造口术显著增加了咳嗽指数。我们强调，比较相似分期肿瘤不同治疗方法的多机构前瞻性生活质量研究对于确定喉癌患者的最佳治疗策略至关重要。
