Lechien Jerome R
Polyclinic of Poitiers, Elsan Hospital, Poitiers, France.
Department of Surgery, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMONS), Mons, Belgium.
Clin Interv Aging. 2024 Dec 13;19:2121-2132. doi: 10.2147/CIA.S475037. eCollection 2024.
In the present study, the findings related to the epidemiology, clinical presentation, and therapeutic outcomes of elderly patients treated with transoral laser microsurgery (TOLM) and transoral robotic surgery (TORS) for supraglottic laryngeal squamous cell carcinoma (LSCC) have been reviewed.
A PubMed, Cochrane Library, and Scopus literature search was conducted according to the PRISMA statements. Critical literature analysis was carried out considering the last advancement in TOLS and TORS, and their related surgical, functional, and survival outcomes.
The mean age of patients with supraglottic LSCCs has progressively increased in the past decades. The data on postoperative complications in elderly patients with LSCC are heterogeneous and contradictory. The thought of the age-related high risk of complications was based on open supraglottic laryngectomy (SGL), but not on TOLM and TORS findings, which do not support an age-related increase of most postoperative complications. The only complication that could be associated with age is aspiration. The adequate selection of patients undergoing TOLM or TORS, and the pre- to postoperative evaluation of swallowing function can prevent this risk. The OS of elderly patients treated with TOLM or TORS SGL could be lower compared to younger patients. However, the disease-free survival was not influenced by age, highlighting the role of comorbidities and intercurrent diseases in the presumed lower survival. The survival analysis could definitively consider the physiological age rather than the chronological age to investigate the impact of age on survival outcomes.
The current literature supports an important place of TOLM and TORS in managing cT1-T3 supraglottic LSCC. The preoperative geriatric, nutritional, and swallowing evaluations are important for ensuring an adequate selection of patients treated with TORS or TOLM SGL.
在本研究中，回顾了经口激光显微手术（TOLM）和经口机器人手术（TORS）治疗声门上型喉鳞状细胞癌（LSCC）的老年患者的流行病学、临床表现和治疗结果。
根据PRISMA声明在PubMed、Cochrane图书馆和Scopus数据库进行文献检索。结合TOLS和TORS的最新进展及其相关的手术、功能和生存结果进行批判性文献分析。
在过去几十年中，声门上型LSCC患者的平均年龄逐渐增加。老年LSCC患者术后并发症的数据存在异质性且相互矛盾。与年龄相关的高并发症风险的观点是基于开放性声门上喉切除术（SGL），而非基于TOLM和TORS的研究结果，后者并不支持大多数术后并发症会随年龄增加而增多。唯一可能与年龄相关的并发症是误吸。对接受TOLM或TORS治疗的患者进行充分选择以及对吞咽功能进行术前至术后评估可预防此风险。与年轻患者相比，接受TOLM或TORS SGL治疗的老年患者的总生存期可能较低。然而，无病生存期不受年龄影响，这突出了合并症和并发疾病在假定较低生存率中的作用。生存分析可以明确考虑生理年龄而非实际年龄来研究年龄对生存结果的影响。
当前文献支持TOLM和TORS在治疗cT1 - T3声门上型LSCC中占有重要地位。术前老年医学、营养和吞咽评估对于确保充分选择接受TORS或TOLM SGL治疗的患者很重要。
