Yuen A P, Wei W I, Ho C M
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
Otolaryngol Head Neck Surg. 1995 Mar;112(3):405-9. doi: 10.1016/S0194-59989570274-1.
The results of surgical salvage of radiation failures of laryngeal carcinoma were reviewed. There were 167 stage T3 and T4 patients. The operative mortality was 7%. The complication rates were 8% wound infection, 13% chest complication, and 25% anastomotic leakage. After the first salvage operation, pharyngeal recurrence developed in 28 (18%) patients. Seven (25%) patients were feasible for second salvage operation, and none of them had further local recurrence. There were 9 (5%) tracheostomal recurrences. Of the 126 N0 patients, 23 (18%) had nodal recurrence, and only 5 of the nodal recurrences were feasible for salvage by radical neck dissection. All 41 node-positive patients underwent radical neck dissection, and 9 (23%) had nodal recurrence. Of the 126 node-negative patients, 19 (15%) had distant metastasis. Of the 41 node-positive patients, 18 (44%) had distant metastasis. The node-positive patients had a significantly high distant failure rate despite locoregional control of tumor. The adjusted 5-year survival rate of T3-4N0M0 was 45%, and that of T3-4N + M0 was 22%.
对喉癌放疗失败后手术挽救的结果进行了回顾。共有167例T3和T4期患者。手术死亡率为7%。并发症发生率分别为：伤口感染8%，胸部并发症13%，吻合口漏25%。首次挽救手术后，28例（18%）患者发生咽复发。7例（25%）患者可行二次挽救手术，且均无进一步局部复发。有9例（5%）气管造口复发。在126例N0患者中，23例（18%）发生淋巴结复发，其中只有5例淋巴结复发可行根治性颈清扫挽救。所有41例淋巴结阳性患者均接受了根治性颈清扫，9例（23%）发生淋巴结复发。在126例淋巴结阴性患者中，19例（15%）发生远处转移。在41例淋巴结阳性患者中，18例（44%）发生远处转移。尽管肿瘤实现了局部区域控制，但淋巴结阳性患者的远处失败率显著较高。T3 - 4N0M0患者调整后的5年生存率为45%，T3 - 4N + M0患者为22%。
