Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Head Neck. 2019 Sep;41(9):3002-3008. doi: 10.1002/hed.25786. Epub 2019 Apr 17.
This study examined the risk factors of pharyngocutaneous fistula development and poor survival after salvage laryngectomy.
Binary logistic regression analyses were carried out to analyze the relationship between post-salvage fistula development and variables. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate prognostic factors associated with disease-free survival (DFS) and overall survival (OS) after salvage laryngectomy.
Multivariate analyses showed that previous radiotherapy and pre-salvage tracheostomy were the independent variables predictive of post-salvage fistula development (all P < .05). The 5-year DFS and OS rates were 58.8% and 45.9%, respectively. Multivariate analyses showed that nodal positivity at salvage remained the independent factor predictive of both DFS (hazard ratio [HR] 2.83, P = .002) and OS (HR 2.22, P = .006).
Fistula development after salvage laryngectomy might be predicted by a history of radiotherapy or tracheostomy. Post-salvage survival is associated with nodal positivity at salvage.
This study examined the risk factors of pharyngocutaneous fistula development and survival in 103 patients who underwent salvage laryngectomy. Previous radiotherapy and tracheostomy were the independent variables predictive of post-salvage fistula development, and nodal positivity at salvage was the independent factor predictive of both disease-free survival and overall survival.
本研究旨在探讨挽救性喉切除术后咽瘘发生和生存不良的危险因素。
采用二项逻辑回归分析，分析挽救性手术后咽瘘发生与变量之间的关系。采用单变量和多变量 Cox 比例风险回归分析，评估与挽救性喉切除术后无病生存率（DFS）和总生存率（OS）相关的预后因素。
多变量分析显示，既往放疗和挽救性气管切开术是预测挽救性手术后咽瘘发生的独立变量（均 P<.05）。5 年 DFS 和 OS 率分别为 58.8%和 45.9%。多变量分析显示，挽救性时淋巴结阳性是预测 DFS（风险比 [HR] 2.83，P=.002）和 OS（HR 2.22，P=.006）的独立因素。
挽救性喉切除术后咽瘘的发生可能与放疗史或气管切开术有关。挽救性手术后的生存与挽救性时淋巴结的阳性状态有关。
