Weyh A M, Mosquera C, Nedrud S, Bunnell A, Fernandes R
Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL, USA.
Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Texas Medical Branch, Galveston, TX, USA.
Int J Oral Maxillofac Surg. 2025 Feb;54(2):103-108. doi: 10.1016/j.ijom.2024.07.005. Epub 2024 Aug 13.
Total glossectomy with laryngectomy (TGL) is a procedure with high morbidity/mortality risks reserved for cases of advanced tongue cancer with laryngeal invasion. This technique is controversial as there are significant impacts on quality of life, including loss of functional speech and swallowing. A systematic review was performed following the PRISMA guidelines with the primary goal of quantifying the functional outcomes and overall survival of patients undergoing TGL. The initial search resulted in 748 studies; seven of these met the inclusion criteria. Five studies evaluated functional speech postoperatively, and 12.1% (8/66) of patients in these studies achieved a form of functional speech. Most studies did not refer to the use of specific postoperative voice rehabilitation. Regarding swallowing function, 53.3% (32/60) of patients in five studies regained their ability to swallow. In six studies reporting gastrostomy tube dependence, 37.7% (29/77) of patients were tube-dependent. Recurrence within 1-year was reported in three studies; 52% (26/50) of the patients had recurrence within 1 year, and the 1-year disease-free survival rate was 48%. TGL is a highly invasive surgery; postoperatively, most patients do not regain the ability to speak, while only half are able to swallow. Despite these extreme efforts and sacrifices by the patient, approximately half of patients have a recurrence within the first year. The decision to perform a TGL should be made only in select and motivated patients after carefully explaining and weighing the oncological and quality of life risks and benefits.
全舌切除术联合喉切除术（TGL）是一种具有高发病率/死亡率风险的手术，仅适用于晚期舌癌伴喉侵犯的病例。该技术存在争议，因为它对生活质量有重大影响，包括功能性言语和吞咽功能丧失。按照PRISMA指南进行了一项系统评价，主要目的是量化接受TGL手术患者的功能结局和总生存率。初步检索得到748项研究；其中7项符合纳入标准。5项研究评估了术后的功能性言语，这些研究中12.1%（8/66）的患者实现了某种形式的功能性言语。大多数研究未提及使用特定的术后嗓音康复方法。关于吞咽功能，5项研究中53.3%（32/60）的患者恢复了吞咽能力。在6项报告胃造瘘管依赖情况的研究中，37.7%（29/77）的患者依赖胃造瘘管。3项研究报告了1年内的复发情况；52%（26/50）的患者在1年内复发，1年无病生存率为48%。TGL是一种侵袭性很强的手术；术后，大多数患者无法恢复言语能力，只有一半患者能够吞咽。尽管患者付出了这些巨大努力和牺牲，但约一半患者在第一年就会复发。只有在仔细解释并权衡肿瘤学及生活质量方面的风险和益处后，对经过挑选且有积极性的患者才能做出实施TGL的决定。
