Vasani Sarju S, Youssef Daniel, Lin Charles, Wellham Annabelle, Hodge Robert
Department of Otolaryngology, Royal Brisbane and Women's Hospital Brisbane Queensland Australia.
Department of Oncology, Royal Brisbane and Women's Hospital Brisbane Queensland Australia.
Laryngoscope Investig Otolaryngol. 2018 Mar 23;3(2):115-120. doi: 10.1002/lio2.144. eCollection 2018 Apr.
Salvage total laryngectomies (STL) are not a homogeneous group. Most will fall into two groups: i) Patients with previous AJCC stage I/II larynx cancer who have had radiotherapy to the larynx only (STL-LOR), or ii) Patients who have had previous AJCC stage III/IV larynx cancer and subsequent radiotherapy to the larynx and draining nodal basins with concurrent cisplatin chemotherapy (STL-CRT). We aimed to compare PCF rates following STL in these two groups.
A retrospective review of the department's cohort between January 2010 and August 2015 was conducted.
Seventy-seven patients underwent total laryngectomy for larynx cancer between January 2010 and August 2015. There were 10 post-laryngectomy fistulas (13.0%). Three of these occurred in the 38 patients undergoing primary total laryngectomy (PTL), and seven in the 39 patients undergoing STL, rates of 7.9% and 17.9%, respectively. Twenty-two patients had received radiation to the larynx alone without chemotherapy (STL-LOR) for initial Stage I/II disease. Eleven patients had received laryngeal and neck irradiation plus cisplatin chemotherapy (STL-CRT) for initial stage III/IV disease. Of the 22 STL-LOR patients, two developed PCF (9.1%). Of the 11 STL-CRT patients, five developed PCF. There was no difference in the rate of PCF between PTL and STL-LOR. There was a statistically significant increase in PCF in STL-CRT versus PTL ( = .009) and in PCF in STL-CRT versus STL-LOR ( = .027).
Salvage laryngectomies are often treated as a homogenous group. We demonstrate that PCF rates vary significantly depending on preoperative radiation fields and the use of chemotherapy.
2b.
挽救性全喉切除术（STL）并非一个同质化的群体。大多数可分为两组：i）既往AJCC I/II期喉癌患者，仅接受过喉部放疗（STL-LOR）；ii）既往AJCC III/IV期喉癌患者，随后接受喉部及引流淋巴结区域放疗并同步顺铂化疗（STL-CRT）。我们旨在比较这两组患者STL术后咽瘘（PCF）发生率。
对2010年1月至2015年8月间该科室队列进行回顾性研究。
2010年1月至2015年8月间，77例患者因喉癌接受全喉切除术。其中有10例发生喉切除术后咽瘘（13.0%）。其中3例发生在38例行初次全喉切除术（PTL）的患者中，7例发生在39例行STL的患者中，发生率分别为7.9%和17.9%。22例患者因初始I/II期疾病仅接受了喉部放疗而未进行化疗（STL-LOR）。11例患者因初始III/IV期疾病接受了喉部及颈部放疗加顺铂化疗（STL-CRT）。在22例STL-LOR患者中，2例发生PCF（9.1%）。在11例STL-CRT患者中，5例发生PCF。PTL与STL-LOR之间的PCF发生率无差异。STL-CRT组与PTL组相比，PCF发生率有统计学显著增加（P = 0.009），STL-CRT组与STL-LOR组相比，PCF发生率也有统计学显著增加（P = 0.027）。
挽救性喉切除术常被视为一个同质化群体。我们证明，PCF发生率因术前放疗范围和化疗的使用而有显著差异。
2b。
