Lavertu P, Bonafede J P, Adelstein D J, Saxton J P, Strome M, Wanamaker J R, Eliachar I, Wood B G
Department of Otolaryngology, Cleveland Clinic Foundation, Ohio 44195, USA.
Arch Otolaryngol Head Neck Surg. 1998 Apr;124(4):401-6. doi: 10.1001/archotol.124.4.401.
To determine the incidence of minor and major complications in patients with squamous cell carcinoma of the upper aerodigestive tract who require surgical salvage or planned neck dissection after an initial treatment regimen with radiotherapy or concurrent chemoradiotherapy for organ preservation.
The medical records of 100 patients treated in a phase 3 trial comparing radiotherapy alone with concurrent chemoradiotherapy for stage III and IV head and neck squamous cell carcinoma were reviewed. Fifty-four patients underwent 59 surgical procedures. Twenty-nine planned neck dissections were performed for persistent neck disease or initial stage N2 or greater. For persistent or recurrent disease at the primary site, 30 salvage operations were performed.
Academic tertiary care referral center.
Complications occurred in 15 (46%) of the 33 procedures in the radiation-only group and 12 (46%) of the 26 procedures in the chemoradiotherapy group. Major complications occurred in 4 (12%) of the procedures in the radiation-only group and 3 (12%) of the procedures in the chemoradiotherapy group. The incidence of minor complications was 33% and 35% in the radiation-only and chemoradiotherapy groups, respectively. The major complication rate for salvage operations did not differ between the radiation-only and chemoradiotherapy groups (16% and 27%, respectively; P=.79 by chi2 test). The incidence of major complications in planned neck dissections was 7% of the radiation-only group and 0% of the chemoradiotherapy group.
After radiation or concurrent chemoradiotherapy, surgery can be performed with an acceptable rate of major complications. Adding chemotherapy did not increase the incidence of surgical complications. These results differ from other reports in the literature.
确定在上消化道鳞状细胞癌患者中，在接受放射治疗或同步放化疗以保留器官的初始治疗方案后，需要手术挽救或计划性颈部清扫的患者中轻微和严重并发症的发生率。
回顾了一项3期试验中100例患者的病历，该试验比较了单独放疗与同步放化疗治疗III期和IV期头颈部鳞状细胞癌的效果。54例患者接受了59次手术。因颈部疾病持续存在或初始为N2期或更高分期而进行了29例计划性颈部清扫。对于原发部位的持续性或复发性疾病，进行了30例挽救手术。
学术性三级医疗转诊中心。
单纯放疗组33例手术中有15例（46%）发生并发症，同步放化疗组26例手术中有12例（46%）发生并发症。单纯放疗组手术中有4例（12%）发生严重并发症，同步放化疗组手术中有3例（12%）发生严重并发症。单纯放疗组和同步放化疗组轻微并发症的发生率分别为33%和35%。单纯放疗组和同步放化疗组挽救手术的严重并发症发生率无差异（分别为16%和27%；卡方检验P = 0.79）。计划性颈部清扫中严重并发症的发生率在单纯放疗组为7%，在同步放化疗组为0%。
放疗或同步放化疗后，手术可在可接受的严重并发症发生率下进行。添加化疗并未增加手术并发症的发生率。这些结果与文献中的其他报道不同。
