Newman J P, Terris D J, Pinto H A, Fee W E, Goode R L, Goffinet D R
Division of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, California 94305-5328, USA.
Ann Otol Rhinol Laryngol. 1997 Feb;106(2):117-22. doi: 10.1177/000348949710600205.
The use of chemotherapy and irradiation for organ preservation attempts to eliminate the need for extensive surgery in patients with advanced squamous cell carcinoma of the head and neck (SCCHN). We sought to characterize the morbidity of surgery in patients who needed surgery after treatment with induction chemotherapy followed by simultaneous chemotherapy and radiotherapy (chemoradiotherapy). The surgical morbidity within the first 30 postoperative days of 17 patients treated in an organ preservation approach between July 1991 and December 1994 was compared with a control group of patients undergoing similar surgical procedures during the same period. The organ preservation study patients underwent surgical procedures consisting of 18 neck dissections and 5 resections of the primary site. Six patients in the organ preservation study group experienced 8 surgical complications within the first 30 postoperative days, and most complications were minor. There was no significant difference in the duration of surgery or length of hospitalization between study patients and matched controls. Our surgical complication rate (35.3%) was higher but not statistically different from that of the control group, and compared favorably to reports of surgical morbidity (44% to 61%) in the literature on patients treated with chemoradiotherapy. The lower complication rate seen in this study may be a reflection of early surgical intervention as part of our organ preservation study scheme, the preponderance of neck dissections performed, and the limited number of pharyngeal procedures performed.
使用化疗和放疗来保留器官，旨在消除晚期头颈部鳞状细胞癌（SCCHN）患者进行广泛手术的必要性。我们试图描述在接受诱导化疗后序贯同步化疗和放疗（放化疗）后仍需手术的患者的手术发病率。将1991年7月至1994年12月间采用保留器官方法治疗的17例患者术后30天内的手术发病率与同期接受类似手术的对照组患者进行比较。保留器官研究组的患者接受了包括18例颈部清扫术和5例原发部位切除术在内的手术。保留器官研究组的6例患者在术后30天内出现了8例手术并发症，且大多数并发症为轻度。研究患者与匹配对照组之间的手术时间或住院时间无显著差异。我们的手术并发症发生率（35.3%）较高，但与对照组无统计学差异，且与文献中关于接受放化疗患者的手术发病率报告（44%至61%）相比更具优势。本研究中观察到的较低并发症发生率可能反映了作为我们保留器官研究方案一部分的早期手术干预、所进行的颈部清扫术占优势以及所进行的咽部手术数量有限。
