Gunasekera Delu, Goel Sahil, Kao Stephen, Krishnan Suren, Hodge John Charles, Foreman Andrew, Stone Jennifer
School of Public Health, The University of Adelaide, Adelaide, SA, Australia.
Department of Otorhinolaryngology Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, SA.
JBI Evid Synth. 2025 Apr 1;23(4):756-764. doi: 10.11124/JBIES-24-00120. Epub 2025 Apr 7.
The objective of this review is to determine the comparative effectiveness of unimodality organ preservation surgery versus radiotherapy on oncological and functional outcomes in patients with early hypopharyngeal cancer.
Early hypopharyngeal cancer is difficult to detect and, therefore, rarely diagnosed, as patients are often asymptomatic. Radiotherapy is considered the main treatment, although this modality has been compared to the previously used open surgical approach, which may not reflect current surgical options. This is reflected in the available literature, with a paucity of data on management guidelines. Minimally invasive surgery is providing better access to the hypopharynx, such as CO 2 laser microsurgery and transoral robotic surgery. These novel surgical procedures may pave the way for revised guidelines to managing hypopharyngeal cancer.
We will include randomized controlled trials and quasi- (or pseudo-randomized) experimental studies that investigate organ preservation surgery and radiotherapy treatments for early hypopharyngeal cancer in adults with primary disease. Primary outcomes include disease-free survival of 2 years or up to 5-year overall survival. Secondary outcomes are functional, including swallowing, phonation, and complications associated with treatment, such as post-procedural hemorrhage; return to theater or operating room; tracheostomizing patients; post-radiation mucositis; dysphagia/odynophagia; and xerostomia.
The review will follow the JBI methodology for systematic reviews of effectiveness. Four databases will be searched: PubMed, Embase (Ovid), CINAHL (EBSCOhost), and the Cochrane Library. Two independent reviewers will screen studies and assess methodological quality using the JBI critical appraisal tools. Individual study estimates will be pooled in a meta-analysis and presented in forest plots.
PROSPERO CRD42023400206.
本综述的目的是确定单模态器官保留手术与放射治疗对早期下咽癌患者肿瘤学和功能结局的比较效果。
早期下咽癌难以检测，因此很少被诊断出来，因为患者通常没有症状。放射治疗被认为是主要治疗方法，尽管这种治疗方式已与先前使用的开放手术方法进行了比较，但这可能无法反映当前的手术选择。现有文献中也体现了这一点，关于管理指南的数据很少。微创手术为进入下咽提供了更好的途径，如二氧化碳激光显微手术和经口机器人手术。这些新颖的手术方法可能为修订下咽癌管理指南铺平道路。
我们将纳入随机对照试验和准（或伪随机）实验研究，这些研究调查针对患有原发性疾病的成年早期下咽癌患者的器官保留手术和放射治疗。主要结局包括2年无病生存率或长达5年的总生存率。次要结局为功能方面，包括吞咽、发声以及与治疗相关的并发症，如术后出血；返回手术室；气管切开术；放疗后粘膜炎；吞咽困难/吞咽痛；以及口干。
本综述将遵循JBI有效性系统评价方法。将检索四个数据库：PubMed、Embase（Ovid）、CINAHL（EBSCOhost）和Cochrane图书馆。两名独立的评审员将筛选研究，并使用JBI批判性评价工具评估方法学质量。个体研究估计值将汇总在荟萃分析中，并以森林图呈现。
PROSPERO CRD42023400206。
