Li Xiao-ming, DI Bin, Tao Zhen-feng, Song Qi, Xiao Shu-fen, Li Hong-xia, Shao Yong-liang
Department of Otorhinolaryngology Head and Neck Surgery, Bethune International Peace Hospital, Shijiazhuang 050082, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 Jul;47(7):532-5.
To explore the plausibility of laryngeal preservation in salvage surgery of recurrent laryngeal carcinoma.
Comprehensive clinical and radiological assessments on a specific group of patients with recurrent laryngeal cancer and their relapsed tumors were carried out to determine the methods and indications of salvage surgery for preservation of laryngeal functions. Salvage surgery with preservation of larynx was performed in a selective of 36 laryngeal cancer patients with relapsed tumors in their larynges after radiotherapy or partial laryngectomies. All patients were regularly followed up after discharge from the hospital. Postoperative survival was calculated by Kaplan-Meier's method.
Among various laryngeal preservation regimens given, a second transoral laser surgery was carried out in 4 cases, horizontal hemilaryngectomy in 4 cases, vertical hemilaryngectomy in 13 cases and Majer-Piquet's operation in 15 cases, respectively. Simultaneous neck dissection was conducted in 18 cases. Postoperative complications were encountered in 6 cases, most common of which were local infection and laryngeal fistula with no hospital mortality and other major morbidities. Five cases with immediate postoperative complications were cured with proper management. The remained one case undergone vertical partial laryngectomy for recurrence after tumor resection via laryngeal fissure received postoperative radiation due to positive surgical margin, and complicated laryngeal atresia and obstruction with loss of his laryngeal functions. Local recurrence was observed in 5 cases and simultaneous locoregional recurrence was seen in 1 case, with the resulting local control rate of 83.3% (30/36). The 3-year postoperative survival rate was 80.6%. The cause of death was tumor recurrence in 3 cases, distant metastasis in 3 cases and non-tumor-associated disease (heart attack) in 1 case, respectively.
Salvage surgery with laryngeal preservation can be carried out in the selected cases with early or locally-confined recurrent lesions within the larynx, on the condition that the recurrent tumors be assessed thoroughly and indications for associated surgical techniques be evaluated properly.
探讨挽救性手术治疗复发性喉癌时保留喉功能的可行性。
对特定组复发性喉癌患者及其复发肿瘤进行全面的临床和影像学评估，以确定保留喉功能的挽救性手术方法及适应证。对36例放疗或部分喉切除术后喉部复发肿瘤的喉癌患者进行了选择性保留喉的挽救性手术。所有患者出院后均定期随访。采用Kaplan-Meier法计算术后生存率。
在各种保留喉的治疗方案中，分别有4例行二次经口激光手术，4例行水平半喉切除术，13例行垂直半喉切除术，15例行Majer-Piquet手术。18例行同期颈淋巴结清扫术。6例出现术后并发症，最常见的是局部感染和喉瘘，无医院死亡及其他严重并发症。5例术后即刻出现并发症经适当处理后治愈。其余1例经喉裂开肿瘤切除术后复发，因手术切缘阳性行垂直部分喉切除术，术后出现喉闭锁和梗阻，失去喉功能。5例出现局部复发，1例出现同期区域复发，局部控制率为83.3%（30/36）。术后3年生存率为80.6%。死亡原因分别为肿瘤复发3例，远处转移3例，非肿瘤相关疾病（心脏病发作）1例。
对于经严格评估复发肿瘤且正确评估相关手术技术适应证的、复发病变早期或局限于喉部的特定病例，可进行保留喉的挽救性手术。
