Tomifuji Masayuki, Araki Koji, Yamashita Taku, Shiotani Akihiro
Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
Eur Arch Otorhinolaryngol. 2014 Mar;271(3):589-97. doi: 10.1007/s00405-013-2575-0. Epub 2013 Jun 1.
In this retrospective cohort study, we evaluated the oncological and functional outcomes of transoral videolaryngoscopic surgery (TOVS). Using distending laryngoscope and videolaryngoscope, wide operative field and working space could be obtained and tumor could be resected in en bloc. Sixty patients with T1, T2, and selected T3 laryngeal or pharyngeal squamous cell carcinomas (Stage I: n = 17, Stage II: n = 16, Stage III: n = 7, Stage IV: n = 20 cases) were enrolled and followed up for at least 24 months or until the patient's death. Fifty-three patients underwent initial treatment, and seven patients had recurrent cancer after chemoradiation. In principle, node-positive patients underwent a simultaneous neck dissection. Patients with multiple nodal metastases or a positive surgical margin received postoperative radiotherapy. For initial treatment, the 5-year overall survival and disease-specific survival rates were 77 and 95 %, respectively. For supraglottic and hypopharyngeal cancers, the 5-year laryngeal preservation rates were 89 and 96 %, respectively. For salvage surgery, the overall survival, disease-specific survival, and laryngeal preservation rates were 75, 75, and 80 %, respectively. The median times before patients could resume eating and swallowing a soft diet were 6 and 9 days, respectively. The patients' Functional Outcome Swallowing Scale stages were 0-2 in 93.3 % of the cases and 3 or 4 in 6.7 % of the cases. A percutaneous endoscopic gastrostomy was indicated for 1 (1.7 %) patient. Four (6.7 %) patients received transient tracheostomy. TOVS is a satisfactory and minimally invasive treatment option for laryngeal and pharyngeal cancers.
在这项回顾性队列研究中，我们评估了经口视频喉镜手术（TOVS）的肿瘤学和功能结局。使用扩张喉镜和视频喉镜，可以获得广阔的手术视野和操作空间，肿瘤能够整块切除。纳入60例T1、T2以及部分T3期喉或下咽鳞状细胞癌患者（Ⅰ期：n = 17例，Ⅱ期：n = 16例，Ⅲ期：n = 7例，Ⅳ期：n = 20例），并对其进行至少24个月的随访或直至患者死亡。53例患者接受了初始治疗，7例患者在放化疗后出现复发性癌症。原则上，淋巴结阳性患者同时行颈部淋巴结清扫术。有多个淋巴结转移或手术切缘阳性的患者接受术后放疗。对于初始治疗，5年总生存率和疾病特异性生存率分别为77%和95%。对于声门上癌和下咽癌，5年喉保留率分别为89%和96%。对于挽救性手术，总生存率、疾病特异性生存率和喉保留率分别为75%、75%和80%。患者恢复进食和吞咽软食的中位时间分别为6天和9天。93.3%的患者功能结局吞咽量表分期为0 - 2期，6.7%的患者为3或4期。1例（1.7%）患者需要行胃造瘘术。4例（6.7%）患者接受了临时性气管切开术。经口视频喉镜手术是治疗喉癌和下咽癌的一种令人满意的微创治疗选择。
