Timmermans Adriana J, Lansaat Liset, Theunissen Eleonoor A R, Hamming-Vrieze Olga, Hilgers Frans J M, van den Brekel Michiel W M
Department of Head and Neck Oncology and Surgery, University of Amsterdam, Amsterdam, the Netherlands.
Ann Otol Rhinol Laryngol. 2014 Mar;123(3):153-61. doi: 10.1177/0003489414522972.
Postoperative complications, especially pharyngocutaneous fistulization (PCF), are more frequent after total laryngectomy (TL) performed for salvage after (chemo)radiotherapy than after primary TL. The aim of this study was to identify the incidence of PCF, predictive factors for PCF, and the relationship of PCF to survival.
We performed a retrospective chart review of 217 consecutive patients treated with TL between 2000 and 2010. Univariate and multivariable analysis with logistic regression was used to identify factors associated with PCF. We used a Kaplan-Meier survival analysis.
The overall incidence of PCF was 26.3% (57 of 217 cases). The incidence of PCF after primary TL was 17.1% (12 of 70), that after salvage TL was 25.5% (25 of 98), that after TLE for a second primary was 37.5% (9 of 24), and that after TL for a dysfunctional larynx was 44.0% (11 of 25). The predictive factors for PCF were hypopharynx cancer (odds ratio [OR], 3.67; 95% confidence interval [CI], 1.74 to 7.71; P = .001), an albumin level of less than 40 g/L (OR, 2.20; 95% CI, 1.12 to 4.33; P = .022), previous chemoradiotherapy (OR, 3.38; 95% CI, 1.34 to 8.52; P = .010), more-extended pharyngeal resection (P = .001), and pharynx reconstruction (P = .002). The median duration of survival was 30 months (95% CI, 17.5 to 42.5); the 2-year overall survival rate was 54%. The median duration of survival of patients with PCF was 23 months (95% CI, 9.4 to 36.6), and that of those without PCF was 31 months (95% CI, 15.0 to 47.0; P = .421). The 2-year overall survival rate was 48% in patients with PCF and 57% in those without PCF (P = .290).
Incidence of PCF after TL is significantly higher in patients with hypopharynx cancer, previous chemoradiotherapy, a low albumin level, more-extended pharyngeal resection, or pharynx reconstruction. The occurrence of PCF does not influence the rate of survival.
与初次全喉切除术（TL）相比，（化疗）放疗后行挽救性TL术后的并发症，尤其是咽皮肤瘘（PCF）更为常见。本研究的目的是确定PCF的发生率、PCF的预测因素以及PCF与生存率的关系。
我们对2000年至2010年间连续接受TL治疗的217例患者进行了回顾性病历审查。采用单因素和多因素逻辑回归分析来确定与PCF相关的因素。我们使用了Kaplan-Meier生存分析。
PCF的总体发生率为26.3%（217例中的57例）。初次TL后PCF的发生率为17.1%（70例中的12例），挽救性TL后为25.5%（98例中的25例），因第二原发性肿瘤行TL后为37.5%（24例中的9例），因喉功能障碍行TL后为44.0%（25例中的11例）。PCF的预测因素为下咽癌（比值比[OR]，3.67；95%置信区间[CI]，1.74至7.71；P = 0.001）、白蛋白水平低于40 g/L（OR，2.20；95% CI，1.12至4.33；P = 0.022）、既往放化疗（OR，3.38；95% CI，1.34至8.52；P = 0.010）、更广泛的咽部切除（P = 0.001）和咽部重建（P = 0.002）。中位生存时间为30个月（95% CI，17.5至42.5）；2年总生存率为54%。发生PCF的患者中位生存时间为23个月（95% CI，9.4至36.6），未发生PCF的患者为31个月（95% CI，15.0至47.0；P = 0.421）。发生PCF的患者2年总生存率为48%，未发生PCF的患者为57%（P = 0.290）。
下咽癌、既往放化疗、白蛋白水平低、更广泛的咽部切除或咽部重建的患者TL术后PCF的发生率显著更高。PCF的发生不影响生存率。
