Rodriguez J, Point D, Brunin F, Jaulerry C, Brugère J
Service de chirurgie cervicofaciale et ORL, Institut Curie, Paris, France.
Bull Cancer Radiother. 1996;83(1):24-30.
Over 40 years after the first commando procedures performed by M Dargent, surgical techniques such as mandibulotomy and myocutaneous flaps yield important changes in oropharyngeal surgery after definitive radiotherapy. Wide resections and simultaneous neck dissection are possible with good functional results. From 1970 to 1990, 250 patients with a carcinoma of the oropharynx were operated on after radiotherapy, 163 because of failure or complication of irradiation, 87 for a metachronous carcinoma occurred in an previously irradiated field. The postoperative mortality rate was 6%. The risk of carotid blow-up did not increase with the extension of the resection. Survival rates at 1, 3 and 5 years are 55%, 22%, 16% in salvage surgery and 69%, 36% and 24% in patients with metachronous cancer. Postoperative complications and failures in the primary and/or the neck account for 60% of causes of death. These results suggest that prior surgery of deeply ulcerative carcinoma of the oropharynx followed by radiotherapy is a better strategy than definitive radiotherapy with salvage surgery in reserve.
在M·达金进行首例突击手术40多年后，下颌骨切开术和肌皮瓣等外科技术使根治性放疗后的口咽外科手术发生了重大变化。广泛切除和同期颈部清扫成为可能，且功能效果良好。1970年至1990年期间，250例口咽癌患者在放疗后接受了手术，其中163例是因为放疗失败或出现并发症，87例是因为在先前放疗区域发生了异时性癌。术后死亡率为6%。颈动脉破裂的风险并未随着切除范围的扩大而增加。挽救性手术患者1年、3年和5年的生存率分别为55%、22%、16%，异时性癌患者的生存率分别为69%、36%和24%。术后并发症以及原发灶和/或颈部的复发占死亡原因的60%。这些结果表明，对于口咽深部溃疡性癌，先进行手术然后放疗，比保留挽救性手术的根治性放疗是更好的策略。
