López Delgado I, Riestra Ayora J, Arenas Brítez O, García López I, Martínez Guirado T, Scola Yurrita B
Department of Otorhinolaryngology, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
Acta Otorhinolaryngol Ital. 2014 Dec;34(6):382-8.
Organ preservation treatment for advanced head and neck squamous cell carcinoma is associated with poor outcomes due to locoregional recurrences. Salvage surgery is the main therapeutic option for some of these patients. The aim of this study was to analyse the results of salvage surgery for advanced pharyngolaryngeal squamous cell carcinoma previously treated with radiochemotherapy. We performed a retrospective study on 38 patients (36 men, 2 women). The median age at diagnosis was 60 years with a mean follow-up period of 49.8 months. Recurrences were diagnosed at a mean of 395 days after finalising organ preservation treatment. Patients went under different salvage surgeries, including 22 total laryngectomies, 6 partial laryngectomies (3 transoral laser surgeries and 3 opened surgeries), 8 functional neck dissections and 2 tongue base surgeries. Nineteen patients had no postoperative complications after a mean hospital stay of 2 weeks. However, 5 patients died of significant recurrent bleedings. There were 4 salivary fistulas that responded to conservative management, while 7 patients had important pharyngostomas that required reconstruction with either regional or free flaps. The mean hospital stay was of 61.60 days for all patients. Five-year overall survival from diagnosis, overall survival after salvage surgery and survival after salvage surgery were 44.20, 37.90 and 45.70%, respectively. In summary, we conclude that salvage surgery is an optimal treatment for pharyngolaryngeal and regional recurrences and provides improvement in locoregional control and survival, despite the severe complications.
由于局部区域复发，晚期头颈部鳞状细胞癌的器官保留治疗效果不佳。挽救性手术是其中一些患者的主要治疗选择。本研究的目的是分析先前接受放化疗的晚期咽喉鳞状细胞癌挽救性手术的结果。我们对38例患者（36例男性，2例女性）进行了回顾性研究。诊断时的中位年龄为60岁，平均随访期为49.8个月。复发平均在器官保留治疗结束后395天被诊断出来。患者接受了不同的挽救性手术，包括22例全喉切除术、6例部分喉切除术（3例经口激光手术和3例开放手术）、8例功能性颈清扫术和2例舌根手术。19例患者平均住院2周后无术后并发症。然而，5例患者死于严重的复发性出血。有4例唾液瘘经保守治疗有效，而7例患者有严重的咽瘘，需要用局部或游离皮瓣进行重建。所有患者的平均住院时间为61.60天。从诊断开始的5年总生存率、挽救性手术后的总生存率和挽救性手术后的生存率分别为44.20%、37.90%和45.70%。总之，我们得出结论，挽救性手术是咽喉及区域复发的最佳治疗方法，尽管有严重并发症，但能改善局部区域控制和生存率。
