经口机器人手术在早期声门上型喉癌手术治疗中的作用。
Role of transoral robotic surgery in surgical treatment of early-stage supraglottic larynx carcinoma.
作者信息
Papazian Michael R, Chow Michael S, Jacobson Adam S, Tran Theresa, Persky Mark S, Persky Michael J
机构信息
NYU Grossman School of Medicine, New York, New York, USA.
Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA.
出版信息
Head Neck. 2023 Apr;45(4):972-982. doi: 10.1002/hed.27325. Epub 2023 Feb 24.
BACKGROUND
There are several options for primary surgical treatment of early-stage supraglottic squamous cell carcinoma (SCC), including transoral robotic surgery (TORS). The purpose of this study was to compare outcomes of TORS to open partial laryngectomy and transoral laser microsurgery (TLM).
METHODS
Patients with clinical classification T1-2 supraglottic SCC diagnosed 2010-2019, treated with TORS, open partial laryngectomy, or TLM in the National Cancer Database were selected.
RESULTS
One thousand six hundred three patients were included: 17% TORS, 26.5% TLM, 56.5% open. TORS patients had the lowest rates of adjuvant treatment (28.4% vs. TLM: 45.0%, open: 38.5%, p < 0.001), and lower positive margin rates than TLM (16.9% vs. 30.5%, p < 0.001). Thirty-day and ninety-day post-operative mortality did not differ between the approaches. Five-year survival was higher following TORS compared to open surgery (77.8% vs. 66.1%, p = 0.01); this difference persisted following matched-pair analysis.
CONCLUSIONS
TORS may be a safe and effective surgical approach for early-stage supraglottic SCC in appropriate patients.
背景
早期声门上型鳞状细胞癌（SCC）的初次手术治疗有多种选择，包括经口机器人手术（TORS）。本研究的目的是比较TORS与开放性部分喉切除术和经口激光显微手术（TLM）的治疗效果。
方法
选取2010 - 2019年在国家癌症数据库中诊断为临床T1 - 2期声门上型SCC并接受TORS、开放性部分喉切除术或TLM治疗的患者。
结果
共纳入1603例患者：17%接受TORS，26.5%接受TLM，56.5%接受开放性手术。TORS患者的辅助治疗率最低（28.4%，TLM为45.0%，开放性手术为38.5%，p < 0.001），切缘阳性率低于TLM（16.9%对30.5%，p < 0.001）。不同手术方式的30天和90天术后死亡率无差异。与开放性手术相比，TORS后的5年生存率更高（77.8%对66.1%，p = 0.01）；配对分析后这种差异仍然存在。
结论
对于合适的患者，TORS可能是早期声门上型SCC的一种安全有效的手术方法。
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