Department of ENT Surgery, Brighton and Sussex County Hospitals, Brighton, UK.
University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
Clin Otolaryngol. 2020 Jul;45(4):558-573. doi: 10.1111/coa.13520. Epub 2020 Apr 7.
The authors provide an updated, systematic and comprehensive summary of the literature concerning management of the N0 neck in patients for whom primary irradiation for squamous cell carcinoma of the larynx has been unsuccessful and salvage surgery in the form of total laryngectomy (TL) advocated.
Bibliographic databases MEDLINE, Cochrane, PubMed and Embase were searched from inception to April 2019, with no language restrictions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Risk of bias was defined using the Joanna Briggs Institute guidelines. Outcome measures were defined as the impact of END on locoregional control, complication rate, disease-specific and overall survival (DSS and OS).
The primary search identified 19 eligible articles, comprising 1353 patients, (1552 ENDs). The overall risk of occult metastases was 14% (9% of ENDs). The relative risk (RR) of developing complications was 1.29 when END was performed, compared to observation of the neck (CI 0.86-1.92). Contrariwise, patients in whom the neck was managed with neck dissection had a decreased risk of developing regional recurrence (RR 0.62, CI 0.35-1.08). There was no statistically significant variation between DSS and OS between END and neck observation groups, respectively.
END during salvage TL may reduce the rate of regional recurrence, but not at the expense of improving DSS or OS. Rates of occult metastases, regional recurrence and "cure" through salvage neck dissection are not equivalent. Significant bias in all collated manuscripts should encourage the reader to interpret conclusions with caution. Patients should be fully involved in the decision-making process and their performance status and co-morbidities taken carefully into account when deciding to increase the extent of surgery, which we believe should remain limited to TL in the majority of cases.
作者提供了一份关于治疗喉鳞状细胞癌患者的 N0 颈部的文献综述，这些患者因原发放疗失败而需要进行挽救性手术，即全喉切除术（TL）。
从创建到 2019 年 4 月，我们在 MEDLINE、Cochrane、PubMed 和 Embase 等文献数据库中进行了无语言限制的检索。我们遵循了系统评价和荟萃分析的首选报告项目（PRISMA）指南。使用 Joanna Briggs 研究所指南定义了偏倚风险。结局指标定义为 END 对局部区域控制、并发症发生率、疾病特异性和总生存率（DSS 和 OS）的影响。
初步搜索确定了 19 篇符合条件的文章，共包括 1353 名患者（1552 次 END）。隐匿性转移的总体风险为 14%（9%的 END）。与观察颈部相比，当进行 END 时，发生并发症的相对风险为 1.29（CI 0.86-1.92）。相反，颈部接受颈清扫术的患者局部区域复发的风险降低（RR 0.62，CI 0.35-1.08）。在 END 和颈部观察组之间，DSS 和 OS 之间没有统计学上的显著差异。
在挽救性 TL 期间进行 END 可能会降低区域复发率，但不会提高 DSS 或 OS。隐匿性转移、区域复发和通过挽救性颈部清扫术“治愈”的几率并不相等。在所有汇总的文献中都存在显著的偏倚，这应该促使读者在解释结论时谨慎行事。在决定是否增加手术范围时，应充分考虑患者的决策过程、表现状态和合并症，并谨慎考虑。我们认为，在大多数情况下，手术范围应仅限于 TL。
