Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital Cancer Center, Catholic University of Louvain, Brussels, Belgium.
Head Neck. 2013 Oct;35(10):1482-9. doi: 10.1002/hed.23174. Epub 2012 Sep 28.
Organ-preservation approaches are frequently favored in the treatment of advanced pyriform sinus carcinoma. In selected cases, use of free flaps allows voice-sparing surgery.
Thirteen patients underwent conservative extended laryngopharyngectomy. In 11 patients, the resection included the supraglottic larynx, whereas the whole hemilarynx was resected in 2. Reconstruction was achieved with a radial forearm free flap with the palmaris longus tendon. In hemilarynx resection, a costal graft was also used. Functional results were assessed by nasofibroscopy and swallowing videofluoroscopic tests.
At 12 months, no patient was gastrostomy dependent, whereas 1 patient remained tracheostomy dependent. At 1, 3, and 5 years, the locoregional control was 100%, 100%, and 83%; overall survival was 69.4%, 46.3%, and 30.8%; and disease-specific survival was 81.2%, 54.5%, and 36.4%, respectively.
In selected patients, extended conservative laryngopharyngectomy challenges the oncologic results of organ-preservation protocols and allows a good quality of life.
在治疗晚期梨状窝癌时，常优先采用器官保留方法。在某些情况下，游离皮瓣的使用可实现保留嗓音的手术。
13 名患者接受了保守性扩展喉咽切除术。11 名患者的切除范围包括声门上喉，2 名患者行半喉切除术。重建采用带掌长肌腱的游离前臂皮瓣。在半喉切除术中，还使用了肋软骨移植物。通过鼻纤维喉镜和吞咽荧光透视检查评估功能结果。
12 个月时，无患者依赖胃造口术，而 1 名患者仍依赖气管造口术。1、3 和 5 年时，局部区域控制率分别为 100%、100%和 83%；总生存率分别为 69.4%、46.3%和 30.8%；疾病特异性生存率分别为 81.2%、54.5%和 36.4%。
在选择的患者中，扩展的保守性喉咽切除术挑战了器官保留方案的肿瘤学结果，并可实现良好的生活质量。
