Yuen A P, Ho C M, Wei W I, Lam L K
Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Head Neck. 1995 Nov-Dec;17(6):526-30. doi: 10.1002/hed.2880170610.
Recurrence is common after total laryngectomy for advanced laryngeal carcinoma. The aim of the present study was to review the prognosis of recurrent laryngeal carcinoma after total laryngectomy.
The records of 165 patients who developed recurrences after total laryngectomy for laryngeal squamous cell carcinoma between January 1971 and December 1990 were reviewed.
Of the 165 patients who developed recurrences, 34 (21%) patients had surgical salvage. The sites of recurrence of these 34 operable patients included 11 pharyngeal, 3 tracheostomal, 15 nodal, 2 pharyngeal with nodal, and 3 pulmonary metastasis. Pharyngeal recurrence had the highest salvage rate, followed by nodal and pulmonary recurrence. All patients with tracheostomal had recurrence after salvage surgery. After the surgical salvage, the tumor recurrence rate was 44% and the 5-year actuarial survival rate was 42%. Of the other 131 patients who had palliative treatment without surgical salvage, the 5-year actuarial survival rate was 2%.
The present study showed that patients who had surgical salvage for recurrent tumor after total laryngectomy had satisfactory prognosis. Close follow-up of patients after initial operation is essential to detect recurrence early, while surgical salvage is still feasible.
晚期喉癌全喉切除术后复发很常见。本研究的目的是回顾全喉切除术后复发性喉癌的预后情况。
回顾了1971年1月至1990年12月期间因喉鳞状细胞癌行全喉切除术后出现复发的165例患者的记录。
在165例出现复发的患者中，34例（21%）患者接受了挽救性手术。这34例可手术患者的复发部位包括11例咽复发、3例气管造口复发、15例淋巴结复发、2例咽合并淋巴结复发以及3例肺转移。咽复发的挽救率最高，其次是淋巴结和肺复发。所有气管造口复发患者在挽救性手术后均再次复发。挽救性手术后，肿瘤复发率为44%，5年精算生存率为42%。在另外131例接受姑息治疗而非挽救性手术的患者中，5年精算生存率为2%。
本研究表明，全喉切除术后复发性肿瘤接受挽救性手术的患者预后良好。初次手术后对患者进行密切随访对于早期发现复发至关重要，而挽救性手术仍然可行。
