Goepfert Ryan P, Hutcheson Katherine A, Lewin Jan S, Desai Neha G, Zafereo Mark E, Hessel Amy C, Lewis Carol M, Weber Randal S, Gross Neil D
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Cancer. 2017 May 15;123(10):1760-1767. doi: 10.1002/cncr.30483. Epub 2016 Dec 27.
The purpose of this study was to describe the 30-day incidence of complications after total laryngectomy (TL) in a high-volume institution and their impact on the hospital length of stay (LOS) and readmission rates.
A retrospective cohort study of all patients who underwent TL at The University of Texas MD Anderson Cancer Center from January 1, 2010 through June 30, 2013 was conducted. The patient demographics, treatment history, LOS, and 30-day post-TL complications and readmissions were extracted from the medical record. Univariate associations were analyzed, and stepwise backward selection methods were used to fit multivariate models.
Two hundred forty-five patients were included. Complications occurred in 83 patients (33.9%) and included 3 deaths (1.2%). Wound complications occurred in 53 patients (21.6%), and 34 were pharyngocutaneous fistulas (PCFs; 13.9% overall). Thirty-four patients (13.9%) were readmitted within 30 days. A multivariate analysis revealed the following: wound complications were associated with former (odds ratio [OR], 5.1; P = .03) and current smokers (OR, 5.8; P = .02), PCFs were associated with prior wide-field radiation (OR, 3.1; P = .01) but not prior narrow-field (larynx-only) radiation (OR, 1.4; P = .61), LOS was associated with the type of flap (P = .002) and postoperative hematomas (P = .05), and readmissions were associated with preoperative hypoalbuminemia (P = .003) and postoperative wound complications (P < .001).
Complications occurred in approximately one-third of TL patients and particularly in patients with poor wound-healing risk factors such as prior smoking and radiation. As expected, LOS was longer among reconstructed patients. Readmission was associated with hypoalbuminemia and postoperative wound complications. These data can inform quality improvement efforts and the counseling of high-risk patients undergoing TL. Cancer 2017;123:1760-1767. © 2016 American Cancer Society.
本研究旨在描述一家大型机构中行全喉切除术（TL）后30天并发症的发生率及其对住院时间（LOS）和再入院率的影响。
对2010年1月1日至2013年6月30日在德克萨斯大学MD安德森癌症中心接受TL的所有患者进行回顾性队列研究。从病历中提取患者的人口统计学信息、治疗史、LOS以及TL术后30天的并发症和再入院情况。分析单因素关联，并采用逐步向后选择法拟合多变量模型。
纳入245例患者。83例患者（33.9%）发生并发症，其中3例死亡（1.2%）。53例患者（21.6%）出现伤口并发症，34例为咽皮肤瘘（PCF；总体发生率为13.9%）。34例患者（13.9%）在30天内再次入院。多变量分析显示：伤口并发症与既往吸烟者（比值比[OR]，5.1；P = 0.03）和当前吸烟者（OR，5.8；P = 0.02）相关，PCF与既往广野放疗相关（OR，3.1；P = 0.01），但与既往窄野（仅喉部）放疗无关（OR，1.4；P = 0.61），LOS与皮瓣类型（P = 0.002）和术后血肿（P = 0.05）相关，再入院与术前低白蛋白血症（P = 0.003）和术后伤口并发症（P < 0.001）相关。
约三分之一的TL患者发生并发症，尤其是有伤口愈合不良危险因素（如既往吸烟和放疗）的患者。正如预期的那样，重建患者的住院时间更长。再入院与低白蛋白血症和术后伤口并发症相关。这些数据可为质量改进工作及接受TL的高危患者的咨询提供参考。《癌症》2017年；123:1760 - 1767。©2016美国癌症协会
