Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China.
Department of Nursing, Eye & ENT Hospital, Fudan University, Shanghai 200031, China.
Am J Otolaryngol. 2022 May-Jun;43(3):103381. doi: 10.1016/j.amjoto.2022.103381. Epub 2022 Feb 3.
Preoperative tracheotomy is an effective option that secures upper airway patency in laryngeal carcinoma patients suffering from upper airway obstruction, but the influence of this treatment on oncologic outcomes of laryngeal carcinoma remains controversial. The purpose of this study was to determine the impact of preoperative tracheotomy on overall survival in supraglottic carcinoma patients with tumor obstruction of the upper airway, and explore the potential causes.
This retrospective study collected 243 consecutive patients with advanced stage supraglottic carcinoma from 2005 to 2010. Preoperative tracheotomy in the management of upper airway obstruction in patients with supraglottic carcinoma was analyzed.
The mean age was 60.9 years at diagnosis, with men accounting for 98.4% of all patients. Thirty nine (16.0%) patients presenting with tumor obstruction of the upper airway required preoperative tracheotomy. T4 stage patients had higher rate of tracheotomy than those of patients with T3 stage (36.8% vs 12.2%). Patients with upper airway obstruction presented with greater tumor area compared with patients without (13.7 cm vs 9.0 cm). The optimal cutoff value of tumor area for tracheotomy and OS rate were both at 10 cm. Supraglottic patients with upper airway obstruction receiving preoperative tracheotomy had poorer OS rate compared with patients without. T stage and tumor area were correlated with upper airway obstruction, and these two variables were independent predictors of OS rate in supraglottic carcinoma patients.
Advanced stage supraglottic carcinoma patients with upper airway obstruction undergoing preoperative tracheotomy experienced worse overall survival. Advanced T stage and greater tumor size were associated with upper airway obstruction, indicating that the negative influence of tumor obstruction on survival may be cause by these two preoperative variables. Therefore, preoperative tracheotomy acts only as an alternative procedure, and is not a prognostic agent.
术前气管切开术是一种有效的方法，可以在患有上气道阻塞的喉癌患者中确保上气道通畅，但这种治疗对上气道阻塞的喉癌患者的肿瘤学结局的影响仍存在争议。本研究旨在确定术前气管切开术对上气道肿瘤阻塞的声门上型癌患者总生存率的影响，并探讨潜在的原因。
本回顾性研究收集了 2005 年至 2010 年间 243 例晚期声门上型癌患者。分析了声门上型癌患者上气道阻塞的术前气管切开术治疗。
诊断时的平均年龄为 60.9 岁，所有患者均为男性，占 98.4%。39 例（16.0%）有上气道肿瘤阻塞的患者需要术前气管切开术。T4 期患者比 T3 期患者气管切开术的发生率更高（36.8%比 12.2%）。有上气道阻塞的患者的肿瘤面积大于无上气道阻塞的患者（13.7cm 比 9.0cm）。肿瘤面积的最佳截点值为 10cm，对气管切开术和 OS 率都是如此。有上气道阻塞的声门上型癌患者接受术前气管切开术的 OS 率较无上气道阻塞的患者差。T 分期和肿瘤面积与上气道阻塞相关，这两个变量是声门上型癌患者 OS 率的独立预测因素。
有上气道阻塞的晚期声门上型癌患者行术前气管切开术的总生存率较差。高级 T 分期和更大的肿瘤大小与上气道阻塞有关，这表明肿瘤阻塞对生存的负面影响可能是由这两个术前变量引起的。因此，术前气管切开术只是一种替代方法，而不是预后因素。
