Bagwell Kenneth, Leder Steven B, Sasaki Clarence T
Yale School of Medicine, Department of Surgery, Section of Otolaryngology, New Haven, CT, United States.
Yale School of Medicine, Department of Surgery, Section of Otolaryngology, New Haven, CT, United States.
Am J Otolaryngol. 2015 May-Jun;36(3):437-41. doi: 10.1016/j.amjoto.2014.11.005. Epub 2014 Nov 20.
Over past decades, function-preserving surgery has been oncologically effective for specific types of laryngeal cancer. Although safe short-term swallow function has been reported, swallow safety during long-term survival has received less attention. The purpose of this report is to highlight potential consequences of late dysphagia and chronic aspiration after partial laryngectomy.
A retrospective case series was performed. The head and neck cancer database from Yale-New Haven Hospital identified 3 patients requiring completion laryngectomy due to chronic aspiration 11-15 years after oncologically successful partial laryngectomy. Demographics, presentation, treatment, and course are included.
Primary treatment was open supraglottic laryngectomy with adjuvant radiation therapy (n=2) and vertical hemilaryngectomy (n=1). All patients demonstrated locoregional control and preservation of swallow function for >10 years postoperatively. Due to late dysphagia and chronic aspiration, two patients required completion laryngectomy 11 and 15 years postoperatively and the third patient will require this 14 years postoperatively.
Successful swallowing after function-preserving laryngeal surgery may not last forever despite adequate control of cancer. Three patients presented with aspiration 11-15 years after partial laryngectomy and required definitive completion laryngectomy. This observation may affect preoperative counseling and consideration for longer post-operative follow-up. The data encourage a larger sample size.
在过去几十年中，保留功能的手术对特定类型的喉癌在肿瘤学上是有效的。尽管已有报道称短期吞咽功能安全，但长期生存期间的吞咽安全性较少受到关注。本报告的目的是强调部分喉切除术后晚期吞咽困难和慢性误吸的潜在后果。
进行了一项回顾性病例系列研究。耶鲁-纽黑文医院的头颈癌数据库确定了3例患者，他们在部分喉切除术后11至15年因慢性误吸而需要进行全喉切除术。纳入了人口统计学、临床表现、治疗和病程等信息。
初始治疗为开放性声门上喉切除术加辅助放疗（n = 2）和垂直半喉切除术（n = 1）。所有患者术后均实现了局部区域控制且吞咽功能保留超过10年。由于晚期吞咽困难和慢性误吸，两名患者分别在术后11年和15年需要进行全喉切除术，第三名患者将在术后14年需要进行该手术。
尽管癌症得到了充分控制，但保留功能的喉手术后成功的吞咽功能可能不会永远持续。3例患者在部分喉切除术后11至15年出现误吸，需要进行确定性的全喉切除术。这一观察结果可能会影响术前咨询以及对更长术后随访时间的考虑。这些数据鼓励进行更大样本量 的研究。
