比较全喉切除术与挽救性喉切除术患者。

Comparison of Patients With Total and Salvage Laryngectomy.

机构信息

Servicio de Otorrinolaringología, Hospital Universitario Arnau de Vilanova, Lérida, Spain; Servicio de Otorrinolaringología, Hospital Universitario Santa María, Lérida, Spain.

出版信息

Acta Otorrinolaringol Esp (Engl Ed). 2021 Nov-Dec;72(6):352-358. doi: 10.1016/j.otoeng.2020.08.005.

DOI:10.1016/j.otoeng.2020.08.005

PMID:34844673

Abstract

INTRODUCTION AND OBJECTIVES

Total laryngectomy (TL) is one of the treatments available in locally advanced laryngeal carcinomas or as a salvage therapy when organ preservation fails, achieving high survival rates and few complications. The aim of this study was to analyse the oncological outcomes, comparing the data obtained with the current literature and analysing complications and survival.

METHODS

The study included 62 patients with primary carcinoma of the larynx treated by primary or salvage TL between 2003 and 2019. We analysed the demographic, clinical and pathological characteristics, tumour stage, complementary treatments, postoperative complications, locoregional recurrences, metastases, and causes of death.

RESULTS

The mean age was 64 years, 90.3% were men, 96.8% were smokers, 43.5% had multiple pathologies and 82.3% had a locally advanced stage. Of all TL 71% were primary and 29% salvage. Neck dissection was performed in 59.6%. Lymphovascular invasion was present in 30.6%, perineural invasion in 30.6% and margin involvement in 14.5%. During the follow-up, 17.7% presented locoregional recurrence and 11.3% distant metastases. Regarding complementary treatments, 56.4% of the patients received adjuvant therapy. The incidence of haemorrhage was 11.3%, infection 14.5%, and pharyngocutaneous fistula 21%. There was a statistically significant correlation between fistula and haemorrhage (P = .000) and between fistula and infection (P = .000). No statistically significant differences were found between the studied factors of primary and salvage TL. The 3-year overall survival was 92% and 5-year overall survival was 88%, finding statistical significance with the locally advanced stage (P = .038), T4 (P = .026), lymphovascular invasion (P = .019) and the involvement of more than 3 lymph nodes in the pathological anatomy (P = .005). On the multivariate analysis, the only variable that showed a significant relationship with survival was lymphovascular invasion (P = .026).

CONCLUSIONS

Although organ preservation is a primary objective, TL remains a leading treatment in locally advanced carcinomas and as salvage in case of failure of medical therapy or partial surgery.

摘要

介绍和目的

全喉切除术（TL）是局部晚期喉癌的治疗方法之一，或者是在器官保留失败时的挽救性治疗，可实现高生存率和较少的并发症。本研究的目的是分析肿瘤学结果，与当前文献中的数据进行比较，并分析并发症和生存率。

方法

本研究纳入了 2003 年至 2019 年间接受原发性或挽救性 TL 治疗的 62 例原发性喉癌患者。我们分析了人口统计学、临床和病理学特征、肿瘤分期、补充治疗、术后并发症、局部复发、转移和死亡原因。

结果

平均年龄为 64 岁，90.3%为男性，96.8%为吸烟者，43.5%有多种合并症，82.3%为局部晚期。所有 TL 中，71%为原发性，29%为挽救性。59.6%行颈清扫术。淋巴管血管侵犯率为 30.6%，神经周围侵犯率为 30.6%，切缘受累率为 14.5%。在随访期间，17.7%出现局部区域复发，11.3%出现远处转移。关于补充治疗，56.4%的患者接受了辅助治疗。出血发生率为 11.3%，感染发生率为 14.5%，咽皮瘘发生率为 21%。瘘管和出血（P=0.000）以及瘘管和感染（P=0.000）之间存在统计学显著相关性。原发性和挽救性 TL 之间的研究因素之间未发现统计学显著差异。3 年总生存率为 92%，5 年总生存率为 88%，局部晚期（P=0.038）、T4（P=0.026）、淋巴管血管侵犯（P=0.019）和病理解剖中累及超过 3 个淋巴结（P=0.005）与生存率存在统计学显著关系。在多变量分析中，唯一与生存有显著关系的变量是淋巴管血管侵犯（P=0.026）。