Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Department of Otolaryngology-Head and Neck Surgery, University of California at Davis, Sacramento, California.
Laryngoscope. 2020 Sep;130(9):2179-2185. doi: 10.1002/lary.28343. Epub 2019 Oct 25.
To compare primary total laryngectomy (TL) versus salvage TL and analyze the functional outcomes, complications, recurrence rates, and survival.
Case series with chart review.
Tertiary care center.
Fifteen-year retrospective analysis of 208 patients with laryngeal squamous cell carcinoma treated by TL was completed. Outcome measures included survival, swallowing rehabilitation, speech rehabilitation, complications, and assessment of comorbidity. Survival estimates were analyzed with Kaplan-Meier method, and regression analysis utilized the Cox proportional hazards model.
Alaryngeal speech was not significantly different between primary TL and salvage TL, 68% versus 82% (P = 0.14). Comparing primary and salvage TL, the perioperative complication rate was 33% versus 48% (P = 0.036). Thirty-six percent of primary TL patients had recurrence compared to 26% of salvage patients. Five-year overall survival rates between primary TL and salvage TL were not significantly different (P = 0.68). Comorbidity was an independent predictor of survival.
Development of a functional voice was not significantly different between salvage and primary TL patients, with a majority achieving alaryngeal speech. Perioperative complications were more prevalent in the salvage TL group. Recurrence and survival are significantly associated with comorbidity status.
4 Laryngoscope, 130:2179-2185, 2020.
比较原发性全喉切除术（TL）与挽救性 TL，并分析功能结果、并发症、复发率和生存率。
病例系列，回顾性图表分析。
三级护理中心。
完成了对 208 例接受 TL 治疗的喉鳞状细胞癌患者的 15 年回顾性分析。结果测量包括生存率、吞咽康复、言语康复、并发症和共病评估。生存估计采用 Kaplan-Meier 法分析，回归分析采用 Cox 比例风险模型。
原发性 TL 和挽救性 TL 之间的无喉言语差异无统计学意义，分别为 68%和 82%（P=0.14）。比较原发性和挽救性 TL，围手术期并发症发生率分别为 33%和 48%（P=0.036）。原发性 TL 患者中有 36%出现复发，而挽救性 TL 患者中有 26%出现复发。原发性 TL 和挽救性 TL 之间 5 年总生存率无显著差异（P=0.68）。共病是生存的独立预测因素。
挽救性 TL 和原发性 TL 患者之间功能性语音的发展没有显著差异，大多数患者都能实现无喉语音。挽救性 TL 组的围手术期并发症更为常见。复发和生存与共病状况显著相关。
4 级喉镜，130：2179-2185，2020。
