原发性咽喉切除术联合空肠游离皮瓣重建：单中心的不断发展的经验。

Primary pharyngolaryngectomy with jejunal free flap reconstruction: a single centre's evolving experience.

机构信息

Department of Otolaryngology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.

School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.

出版信息

ANZ J Surg. 2020 Oct;90(10):1965-1969. doi: 10.1111/ans.15930. Epub 2020 May 1.

DOI:10.1111/ans.15930

PMID:32356604

Abstract

BACKGROUND

Head and neck squamous cell carcinoma, and in particular hypopharyngeal squamous cell carcinoma, has long been associated with disfiguring treatment options, significant morbidity and limited long-term survival outcomes. Total pharyngolaryngectomy (TPL) with free flap reconstruction followed by post-operative radiation therapy or chemoradiotherapy is a widely accepted treatment of choice for advanced disease of the hypopharynx.

METHODS

Our unit undertook a 11-year review of all primary TPL patients aiming to provide an update on survival outcomes, morbidity, post-operative complications and evolving management strategies. We report one of the largest single-centre series to date with 89 patients undergoing primary TPL between 2003 and 2013, and compare these outcomes to 180 patients undergoing TPL at the same facility in the previous 23 years.

RESULTS

Between study periods, we saw a shift in patient population towards higher stage disease (T-stage 3 or 4 97% 2003-2013; 68% 1979-2002) and increased nodal involvement (node positive 88% 2003-2013; 70% 1979-2002) without a subsequent reduction in 5-year disease-specific survival (52% 2003-2013; 52% 1979-2002) or 5-year overall survival (32% 2003-2013; 33% 1979-2002).

摘要

背景

头颈部鳞状细胞癌，特别是下咽鳞状细胞癌，长期以来一直与毁容的治疗选择、显著的发病率和有限的长期生存结果相关。全咽喉切除术（TPL）联合游离皮瓣重建，然后行术后放疗或放化疗，是治疗下咽晚期疾病的广泛接受的治疗选择。

方法

我们的团队对所有原发性 TPL 患者进行了为期 11 年的回顾性研究，旨在提供生存结果、发病率、术后并发症和不断发展的管理策略的最新信息。我们报告了迄今为止最大的单一中心系列之一，共有 89 例患者在 2003 年至 2013 年间接受了原发性 TPL，将这些结果与在同一机构的 180 例在之前 23 年接受 TPL 的患者进行比较。

结果

在研究期间，我们看到患者人群向更高分期疾病（T 分期 3 或 4，97%，2003-2013 年；68%，1979-2002 年）和更高的淋巴结受累（阳性淋巴结 88%，2003-2013 年；70%，1979-2002 年）转移，但 5 年疾病特异性生存率（52%，2003-2013 年；52%，1979-2002 年）或 5 年总生存率（32%，2003-2013 年；33%，1979-2002 年）没有相应下降。