Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0012, USA.
Otolaryngol Head Neck Surg. 2011 Nov;145(5):755-8. doi: 10.1177/0194599811412724. Epub 2011 Jun 13.
To compare functional and survival outcomes for patients undergoing total glossectomy (TG) or total glossectomy plus laryngectomy (TGL) for advanced squamous cell carcinoma (SCC) of the tongue.
Case series with chart review.
Academic tertiary referral center.
There were 30 included patients (20 TG, 10 TGL). Outcomes included tumor recurrence, disease-free survival, and functional data (swallowing, gastrostomy tube dependence, speech, airway).
Mean patient age was 56 years with a male predominance (90%). Compared with TG, TGL was more commonly performed for recurrent tumors (90% vs 55%, P = .06). Perineural invasion and extracapsular extension occurred more commonly in the TGL group (80% vs 50%, P = .12). At 12 months postoperatively, 61% of TG patients had disease recurrence compared with 40% of TGL patients (P = .43), and 12-month disease-free survival was 40% (TG) and 50% (TGL). Functionally, more TG patients were totally gastrostomy tube dependent (70% vs 30%, P = .04), and 50% of TG patients were also tracheostomy dependent. Intelligible speech was achieved by 30% of TG and 10% of TGL patients (P = .68).
Patients undergoing TGL had similar functional and survival outcomes to patients undergoing TG alone despite the presence of more locally advanced disease with greater adverse pathological features. Following TG alone, positive or close margins occurred most commonly at the inferior margin of resection (hyoid/valleculae), which could explain why TGL in patients with advanced tongue SCC may improve local disease control.
比较全舌切除术（TG）或全舌切除术加喉切除术（TGL）治疗晚期舌鳞状细胞癌（SCC）患者的功能和生存结果。
病例系列和图表回顾。
学术三级转诊中心。
共有 30 名患者纳入研究（20 名 TG，10 名 TGL）。结果包括肿瘤复发、无病生存率和功能数据（吞咽、胃造口管依赖、言语、气道）。
平均患者年龄为 56 岁，男性居多（90%）。与 TG 相比，TGL 更常用于治疗复发性肿瘤（90%对 55%，P =.06）。神经周围侵犯和囊外扩展在 TGL 组更常见（80%对 50%，P =.12）。术后 12 个月，TG 患者中有 61%出现疾病复发，而 TGL 患者中有 40%（P =.43），12 个月无病生存率为 40%（TG）和 50%（TGL）。在功能方面，更多的 TG 患者完全依赖胃造口管（70%对 30%，P =.04），50%的 TG 患者也需要气管造口术。30%的 TG 患者和 10%的 TGL 患者能够说出清晰的言语（P =.68）。
尽管 TGL 患者存在更多局部晚期疾病和更多不利的病理特征，但与单独接受 TG 治疗的患者相比，TGL 患者具有相似的功能和生存结果。单独接受 TG 治疗后，阳性或接近切缘最常见于切除的下边缘（舌骨/ valleculae），这可以解释为什么在晚期舌 SCC 患者中进行 TGL 可能会改善局部疾病控制。
