Schwaab G, Mamelle G, Lartigau E, Parise O, Wibault P, Luboinski B
Department of Head and Neck Surgery, Institut Gustave-Roussy, Villejuif, France.
Am J Surg. 1994 Nov;168(5):474-5. doi: 10.1016/s0002-9610(05)80104-7.
To evaluate the use of conservative surgical salvage techniques (eg, vertical partial laryngectomy and subtotal laryngectomy with cricohyoidopexy) versus total laryngectomy for radiotherapeutic failure of early glottic cancer by retrospective review of medical records.
Of 950 previously untreated endolaryngeal carcinomas managed at the Gustave-Roussy Institute in France between 1975 and 1984, 259 of 344 early glottic cancers (T1, N0 and T2, N0) received radiation therapy. Local failure rates were 14% in T1a cancers, 16% in T1b cancers, and 36% in T2 cancers with normal vocal-cord mobility.
Nine of 54 patients with treatment failure were ineligible for salvage surgery. Among the remaining 45 patients, 35 underwent a total laryngectomy; these patients had a 77% 5-year survival rate. Ten patients treated with partial surgery (6 vertical partial laryngectomies and 4 subtotal laryngectomies with cricohyoidopexy) had a 100% survival rate at 5 years. Seven of the 10 patients treated with partial surgery had healing problems that delayed canula and nasogastric tube removal for 30 to 60 days.
Salvage surgery is effective for radiotherapeutic failures of early glottic cancers. In some cases, partial surgery can be performed with good tumor control and satisfactory laryngeal functions. Subtotal laryngectomy is an alternative to total laryngectomy if vertical partial surgery is not suitable.
通过回顾病历，评估保守性手术挽救技术（如垂直部分喉切除术和环状软骨舌骨固定术的次全喉切除术）与全喉切除术治疗早期声门癌放疗失败的效果。
1975年至1984年间，法国古斯塔夫 - 鲁西研究所治疗了950例未经治疗的喉内癌，其中344例早期声门癌（T1，N0和T2，N0）中的259例接受了放射治疗。声带活动正常的T1a癌局部失败率为14%，T1b癌为16%，T2癌为36%。
54例治疗失败的患者中有9例不符合挽救手术条件。其余45例患者中，35例行全喉切除术；这些患者的5年生存率为77%。10例行部分手术的患者（6例垂直部分喉切除术和4例环状软骨舌骨固定术的次全喉切除术）5年生存率为100%。10例行部分手术的患者中有7例出现愈合问题，导致套管和鼻胃管拔除延迟30至60天。
挽救手术对早期声门癌放疗失败有效。在某些情况下，部分手术可以实现良好的肿瘤控制和满意的喉功能。如果垂直部分手术不合适，次全喉切除术是全喉切除术的替代方案。
