Kraus D H, Pfister D G, Harrison L B, Spiro R H, Strong E W, Zelefsky M, Bosl G J, Shah J P
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Ann Otol Rhinol Laryngol. 1995 Dec;104(12):936-41. doi: 10.1177/000348949510401204.
From 1983 to 1991, 31 patients underwent salvage laryngectomy for persistent or recurrent squamous carcinoma of the larynx (14), hypopharynx (15), or oropharynx (2) as part of a larynx preservation protocol. Laryngectomy was performed as a consequence of poor response to induction chemotherapy in 13 and for recurrent disease after completion of chemotherapy and irradiation in 18. Postoperative pharyngocutaneous fistula occurred in 39%, resulting in prolonged hospitalization. Local control was achieved in 68%, more often in patients with laryngeal as opposed to nonlaryngeal primaries (86% versus 53%; p = .05). The overall actuarial survival and disease-specific survival at 2 years were 32% and 38%, respectively. Disease-specific survival at 2 years was better in patients with laryngeal as compared to nonlaryngeal primaries (56% versus 24%; p = .02). There were no long-term survivors among the nonlaryngeal primary patients. In selected patients in whom larynx preservation failed, salvage laryngectomy was associated with acceptable local control and survival. Palliation was obtained in patients who were not cured by their laryngectomy. Future investigation will focus on identification of factors predicting complications and strategies to reduce the incidence and severity.
1983年至1991年期间，作为喉保留方案的一部分，31例患者因喉（14例）、下咽（15例）或口咽（2例）持续性或复发性鳞状细胞癌接受了挽救性喉切除术。13例患者因诱导化疗反应不佳而进行喉切除术，18例患者在完成化疗和放疗后因疾病复发而进行喉切除术。术后咽皮肤瘘发生率为39%，导致住院时间延长。68%的患者实现了局部控制，喉原发性患者比非喉原发性患者更常实现局部控制（86%对53%；p = 0.05）。2年时的总体精算生存率和疾病特异性生存率分别为32%和38%。与非喉原发性患者相比，喉原发性患者2年时的疾病特异性生存率更高（56%对24%；p = 0.02）。非喉原发性患者中没有长期存活者。在喉保留失败的特定患者中，挽救性喉切除术与可接受的局部控制和生存率相关。未通过喉切除术治愈的患者获得了姑息治疗。未来的研究将集中于确定预测并发症的因素以及降低发病率和严重程度的策略。
