头颈部癌挽救性颈清扫术的临床结局与初始治疗、手术范围及患者因素的关系
Clinical outcome of salvage neck dissections in head and neck cancer in relation to initial treatment, extent of surgery and patient factors.
作者信息
van den Bovenkamp K, Noordhuis M G, Oosting S F, van der Laan B F A M, Roodenburg J L, Bijl H P, Halmos G B, Plaat B E C
机构信息
Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
出版信息
Clin Otolaryngol. 2017 Jun;42(3):693-700. doi: 10.1111/coa.12818. Epub 2017 Jan 24.
OBJECTIVE
Salvage surgery has a higher complication rate compared to primary surgical treatment. We evaluated clinical outcome of salvage neck dissections in relation to initial treatment modality, extent of surgery and patient-related factors.
DESIGN
Single institution consecutive case series.
SETTING
Tertiary Head and Neck Cancer Centre.
PARTICIPANTS
In all, 87 patients with head and neck squamous cell carcinoma, who underwent salvage neck dissection after initial radiotherapy (n = 30), radiotherapy with carboplatin/5-fluorouracil (n = 43) or radiotherapy with cetuximab (n = 14).
MAIN OUTCOME MEASURES
Incidence of complications, disease-specific survival.
RESULTS
Complications occurred in 28% of the patients. Multivariate analysis identified extent of neck dissection as the only independent predictor of surgical complications (P = 0.010). Surgical complication rate was 16% after radiotherapy with systemic treatment, and 47% after radiotherapy alone (P = 0.171). The 5-year disease-specific survival was 55%, independent of complications, initial treatment, extent of surgery and patient-related factors.
CONCLUSION
The only predictor for surgical complications was extent of surgery. Survival was not influenced by complications.
目的
挽救性手术与初次手术治疗相比，并发症发生率更高。我们评估了挽救性颈清扫术的临床结局与初始治疗方式、手术范围及患者相关因素之间的关系。
设计
单机构连续病例系列。
地点
三级头颈癌中心。
参与者
总共87例头颈部鳞状细胞癌患者，他们在初始放疗（n = 30）、放疗联合卡铂/5-氟尿嘧啶（n = 43）或放疗联合西妥昔单抗（n = 14）后接受了挽救性颈清扫术。
主要观察指标
并发症发生率、疾病特异性生存率。
结果
28%的患者发生了并发症。多因素分析确定颈清扫范围是手术并发症的唯一独立预测因素（P = 0.010）。全身治疗放疗后的手术并发症发生率为16%，单纯放疗后的手术并发症发生率为47%（P = 0.171）。5年疾病特异性生存率为55%，与并发症、初始治疗、手术范围及患者相关因素无关。
结论
手术并发症的唯一预测因素是手术范围。生存率不受并发症影响。
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