Chevalier D, Laccourreye O, Brasnu D, Laccourreye H, Piquet J J
Department of Otorhinolaryngology-Head and Neck Surgery, Claude Huriez Hospital, University Lille II, France.
Ann Otol Rhinol Laryngol. 1997 May;106(5):364-9. doi: 10.1177/000348949710600502.
The medical charts and operative files of 112 patients (combined inception cohort) with well to moderately differentiated invasive glottic squamous cell carcinoma presenting fixation (22) or impaired motion (90) of the true vocal cord (TVC) consecutively treated with cricohyoidoepiglottopexy (CHEP) at our institutions from 1972 to 1989 were retrospectively reviewed. A minimum 5-year follow-up was always achieved. The Kaplan-Meier 5-year actuarial survival, local recurrence, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate for the entire group of patients were 84.7%, 5.4%, 6.4%, 1.2%, and 10.8%, respectively. The 5-year absolute and cause-specific survival rates were 85.5% and 94.1% for patients with fixation of the TVC and 81.3% and 96% for patients with impaired motion of the TVC. The 5-year actuarial local control rates for patients with fixation or impaired motion of the TVC were 95.4% and 94.4%, respectively. Local recurrence was statistically more likely in patients with positive margins (p = .007). Nodal recurrence was statistically more likely in patients with local recurrence (p = .005). Permanent tracheostomy related to postoperative laryngeal stenosis was requested in 2 patients. Aspiration-related completion total laryngectomy and/or permanent gastrostomy were never requested. Overall, local control and laryngeal preservation were achieved in 97.3%, and 95.5% of patients, respectively. At our institutions, the change from the conservative treatment modalities of radiotherapy and vertical partial laryngectomy to CHEP has brought about an increase in long-term survival, local control, and laryngeal preservation rates when compared to historical controls using vertical partial laryngectomy or radiotherapy.
回顾性分析了1972年至1989年在我们机构连续接受环舌会厌固定术（CHEP）治疗的112例（合并起始队列）声门浸润性鳞状细胞癌患者的病历和手术记录，这些患者的肿瘤分化良好至中度分化，表现为声带固定（22例）或活动受限（90例）。所有患者均获得了至少5年的随访。整个患者组的Kaplan-Meier 5年精算生存率、局部复发率、淋巴结复发率、远处转移率和异时性第二原发性肿瘤估计值分别为84.7%、5.4%、6.4%、1.2%和10.8%。声带固定患者的5年绝对生存率和病因特异性生存率分别为85.5%和94.1%，声带活动受限患者分别为81.3%和96%。声带固定或活动受限患者的5年精算局部控制率分别为95.4%和94.4%。切缘阳性患者局部复发的统计学可能性更高（p = 0.007）。局部复发患者淋巴结复发的统计学可能性更高（p = 0.005）。2例患者因术后喉狭窄需要永久性气管切开术。从未要求进行与误吸相关的全喉切除术和/或永久性胃造口术。总体而言，分别有97.3%和95.5%的患者实现了局部控制和喉保留。在我们机构，与采用垂直部分喉切除术或放疗的历史对照相比，从放疗和垂直部分喉切除术的保守治疗方式转变为CHEP带来了长期生存率、局部控制率和喉保留率的提高。
