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挽救性环状软骨上部分喉切除术的肿瘤学及功能学结果

Oncologic and functional outcomes of salvage supracricoid partial laryngectomy.

作者信息

Kim Ji Hoon, Kim Won Shik, Koh Yoon Woo, Kim Se-Heon, Byeon Hyung Kwon, Choi Eun Chang

机构信息

a Department of Otorhinolaryngology-Head and Neck Surgery , Yonsei University Wonju College of Medicine , Ilsanro , Wonju , Korea.

b Department of Otorhinolaryngology-Head and Neck Surgery , Seoul National University , Gwanak-gu , Seoul , Korea.

出版信息

Acta Otolaryngol. 2018 Dec;138(12):1117-1122. doi: 10.1080/00016489.2018.1506154. Epub 2019 Jan 31.

Abstract

BACKGROUND

Supracricoid partial laryngectomy (SCL) can have a positive impact on patients' quality of life by circumventing dysphagia and voice problems resulting from creation of a permanent stoma after conventional total laryngectomy (TL) surgery.

AIMS/OBJECTIVES: The aim of this study was to investigate the oncologic and functional outcomes of salvage SCL for recurrent laryngeal carcinoma.

MATERIAL AND METHODS

Forty-five patients that underwent salvage surgery for recurrent laryngeal carcinoma between January 2004 and May 2015 after initial treatment failure were included in this retrospective study.

RESULTS

Overall survival and disease free survival were non-significantly higher in the salvage SCL group (n = 14) than in the salvage TL group (n = 31) (87.5 versus 56.5%, 53.4 versus 41.9%). Multivariate analyses showed only positive resection margin to be significantly associated with survival and recurrence (HR 9.974, p = .007, and HR 9.196, p = .002, respectively). In the salvage SCL group, 92.8% achieved successful decannulation and all patients returned to an oral diet. All patients in the salvage TL group sustained a permanent stoma and conversation was possible only through esophageal voice or a voice prosthesis. 74.2% of patients in the group were able to tolerate an oral diet.

CONCLUSIONS AND SIGNIFICANCE

Salvage SCL showed comparable oncologic outcomes and favorable functional outcomes relative to the classic salvage TL. This study could provide a sufficient basis of SCL as salvage treatment for recurrent laryngeal carcinoma in selected patients.

摘要

背景

环状软骨上部分喉切除术(SCL)可避免传统全喉切除术(TL)术后因永久性造口导致的吞咽困难和嗓音问题,从而对患者的生活质量产生积极影响。

目的

本研究旨在探讨挽救性SCL治疗复发性喉癌的肿瘤学及功能学结果。

材料与方法

本回顾性研究纳入了2004年1月至2015年5月期间因初始治疗失败而接受复发性喉癌挽救性手术的45例患者。

结果

挽救性SCL组(n = 14)的总生存率和无病生存率略高于挽救性TL组(n = 31)(分别为87.5%对56.5%,53.4%对41.9%),但差异无统计学意义。多因素分析显示,仅切缘阳性与生存及复发显著相关(HR分别为9.974,p = 0.007;HR为9.196,p = 0.002)。在挽救性SCL组中,92.8%的患者成功拔管,所有患者恢复经口饮食。挽救性TL组的所有患者均有永久性造口,仅能通过食管语音或语音假体进行交流。该组74.2%的患者能够耐受经口饮食。

结论与意义

相对于经典的挽救性TL,挽救性SCL显示出相当的肿瘤学结果和良好的功能学结果。本研究可为选定患者采用SCL作为复发性喉癌的挽救性治疗提供充分依据。

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