Leone C A, Capasso P, Topazio D, Russo G
Otolaryngology Head and Neck Surgery Unit of "Azienda Ospedaliera di Rilievo Nazionale dei Colli, Ospedale Monaldi", Naples, Italy.
Acta Otorhinolaryngol Ital. 2016 Dec;36(6):439-449. doi: 10.14639/0392-100X-1063.
Residual or recurrent laryngeal cancer after irradiation is a difficult clinical problem with a rate that ranges from 13% to 36% of cases. Supracricoid laryngectomy (SCL) with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) provide reliable oncological and functional results for selected primary and recurrent patients with glottic and supraglottic carcinomas. We conducted a systematic review and meta-analysis to assess the oncological and functional outcomes of patients treated with open partial horizontal laryngectomy types IIa and IIb (CHEP, CHP) in terms of the recurrence of squamocellular cancer of the larynx after radiotherapy failure. The databases searched included MEDLINE, PubMed and EMBASE (from January 1990 to December 2015, English language). The meta-analysis was performed with a mixed random effects model using the DerSimonian and Laird method. The heterogeneity was measured with the I statistic. Fourteen papers out of 276 were included and comprised a total of 291 patients. The five-year overall survival was 80.2% (CI 0.719-0.885; I = 62%; p = 0.003), and the 5-year disease-free survival was 89.5% (CI 0.838-0.952; I = 52%; p = 0.022). The indications for SCL after the failure of radiation therapy (RT) were similar to those specified for previously untreated patients. We therefore hypothesised that careful assessment of tumour extension might be responsible for the high 5-year OS and 5-year DFS. The early postoperative recovery outcomes indicated that the mean time until decannulation was 35.6 days (CI 24.3-46.9; I = 95%; p < 0.001), and the mean time until nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG) removal was 28.3 days (CI 22.7-33.8; I = 86%; p< = 0.001). These data are according to authors who prefer the initial removal of the NGT and the initiation of oral alimentation with a tracheostomy tube to protect and clean the airways and permit the suction of any residual food that might be present.
放疗后残留或复发的喉癌是一个棘手的临床问题，其发生率在病例总数的13%至36%之间。环状软骨上喉切除术（SCL）联合环舌固定术（CHP）或环舌会厌固定术（CHEP），对于部分选定的声门型和声门上型原发性及复发性癌患者，能提供可靠的肿瘤学和功能学结果。我们进行了一项系统评价和荟萃分析，以评估IIa型和IIb型开放性部分水平喉切除术（CHEP、CHP）治疗的患者在放疗失败后喉鳞状细胞癌复发方面的肿瘤学和功能学结局。检索的数据库包括MEDLINE、PubMed和EMBASE（1990年1月至2015年12月，英文文献）。采用DerSimonian和Laird方法的混合随机效应模型进行荟萃分析。用I统计量测量异质性。276篇论文中有14篇被纳入，共291例患者。五年总生存率为80.2%（CI 0.719 - 0.885；I = 62%；p = 0.003），五年无病生存率为89.5%（CI 0.838 - 0.952；I = 52%；p = 0.022）。放疗失败（RT）后SCL的适应证与先前未治疗患者的规定相似。因此，我们推测对肿瘤扩展的仔细评估可能是导致高五年总生存率和五年无病生存率的原因。术后早期恢复结果表明，拔管的平均时间为35.6天（CI 24.3 - 46.9；I = 95%；p < 0.001），鼻胃管（NGT）或经皮内镜下胃造口术（PEG）拔除的平均时间为28.3天（CI 22.7 - 33.8；I = 86%；p <= 0.001）。这些数据来自那些倾向于最初拔除NGT并通过气管造口管开始经口进食以保护和清洁气道，并允许吸出可能存在的任何残留食物的作者。
