Department of Surgery, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology, Elsan Hospital, Poitiers, France; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Brussels, Belgium.
Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France.
Oral Oncol. 2024 Nov;158:107009. doi: 10.1016/j.oraloncology.2024.107009. Epub 2024 Sep 1.
This review aimed to investigate the surgical, functional, and oncological outcomes of transoral laser microsurgery supraglottic laryngectomy (TOLM-SGL) for cT1-T3 laryngeal cancers.
PubMed, Scopus, and Cochrane Library were searched by two independent investigators for studies investigating the surgical, functional, and oncological outcomes of TOLM-SGL using the PRISMA statements. A bias analysis was carried out with MINORS.
Twenty-four studies were included (937 patients), including 206 (25.9 %) cT1, 467 (58.7 %) cT2, and 123 (15.4 %) cT3 cases. Most patients were cN0 (63.9 %). The mean hospital stay of TOLM was 10.1 days. Aspiration (5.5 %), and bleeding (5.3 %) were the most prevalent complications. The laryngeal preservation rate was 93.7 %. Temporary tracheotomy was performed in 18.0 % of patients, with a mean time of decannulation of 6.8 days. A feeding tube was placed in 59.9 % of patients. The oral diet restarted after 6.4 days. Definitive gastrostomy was necessary in 2.4 % of cases. The 5-year OS and DFS were 70.1 % and 82.0 %, respectively. Distant metastasis, local, and regional recurrence occurred in 4.6 %, 11.6 %, and 5.1 % of patients. There was an important heterogeneity between studies for inclusion criteria, patient profiles, TOLM indications, and details of surgical, functional, and oncological outcomes.
TOLM supraglottic laryngectomy is a safe, and effective procedure associated with adequate functional, surgical, and oncological outcomes. Future studies are needed to define the place of TOLM in advanced LSCC; the role and timing of concomitant bilateral neck dissection, the indications of tracheotomy and feeding tube.
本综述旨在探讨经口激光显微手术（TOLM）行声门上型喉切除术（SGL）治疗 T1-T3 期喉癌的手术、功能和肿瘤学结果。
两位独立研究员按照 PRISMA 声明，通过 PubMed、Scopus 和 Cochrane Library 检索探讨 TOLM-SGL 手术的手术、功能和肿瘤学结果的研究。采用 MINORS 进行偏倚分析。
共纳入 24 项研究（937 例患者），包括 206 例（25.9%）cT1 期、467 例（58.7%）cT2 期和 123 例（15.4%）cT3 期病例。大多数患者为 cN0（63.9%）。TOLM 的平均住院时间为 10.1 天。最常见的并发症为吸入（5.5%）和出血（5.3%）。喉保留率为 93.7%。18.0%的患者行临时气管切开术，平均拔管时间为 6.8 天。59.9%的患者放置了饲管。6.4 天后开始经口进食。2.4%的病例需要进行确定性胃造口术。5 年 OS 和 DFS 分别为 70.1%和 82.0%。远处转移、局部和区域复发分别发生在 4.6%、11.6%和 5.1%的患者中。由于纳入标准、患者特征、TOLM 适应证以及手术、功能和肿瘤学结果的详细信息存在显著异质性，因此各研究间存在显著异质性。
TOLM 行声门上型喉切除术是一种安全有效的手术，可获得良好的功能、手术和肿瘤学结果。未来需要研究来明确 TOLM 在晚期 LSCC 中的地位；双侧颈清扫术的作用和时机、气管切开术和饲管的适应证。
