挽救性口咽切除术后的手术和功能效果。

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2024-10-03 DOI:10.1016/j.oraloncology.2024.107050

Logesvar Balaguru , Krishna S. Hanubal , Zhanna Galochkina , Ji-Hyun Lee , Linda Chow , Dustin Conrad , Peter T. Dziegielewski

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引用次数: 0

摘要

目的：放疗（RT）失败后通过游离瓣重建进行口咽挽救手术会面临独特的挑战和并发症。本回顾性研究的目的是研究因复发或顽固性口咽癌接受放疗后挽救手术的患者的手术并发症和功能预后：根据头颈部肿瘤学团队的住院和门诊记录，确定2016-2021年间在佛罗里达大学确诊为口咽癌并接受挽救性口咽切除术的患者。测量的结果包括气管造口依赖性、管饲依赖性和完整口服状态。采用 Kaplan-Meier 乘积极限法计算生存结果：分析共纳入 26 名患者。平均年龄为 63.7 岁。14例（53.8%）口咽切除术采用了经下颌途径，10例（38.5%）采用了经口和经颈联合途径，2例（7.7%）采用了经颈途径。气管造口术平均拆线时间为 25.1 天。6 个月后，20 名患者（83.3%）可独立使用胃管，其中 12 名患者（54.2%）可耐受任何口服食物。12 个月时，独立使用胃管进食的患者减少到 9 人（60%），其中 13 人（92.9%）可以经口进食。中位总生存期为 27 个月，最常见的死亡原因是局部癌症复发。因疾病复发而接受挽救性口咽切除术的患者仍需面对长期的气管造口术和插管喂养。尽管吞咽功能完好，但患者仍倾向于使用胃管喂养，这可能是为了快速、轻松和方便。需要进一步研究分析影响这些相互矛盾的功能结果的因素以及影响存活率的预测因素。

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Surgical and functional outcomes after salvage oropharyngectomy

Objectives

Salvage oropharyngeal surgery with free-flap reconstruction after failed radiation therapy (RT) presents unique challenges and complications. The aim of this retrospective review is to examine surgical complications and functional outcomes in patients who received salvage surgery for recurrent or persistent oropharyngeal cancer following RT.

Patients and Methods

Patients diagnosed with oropharyngeal cancer and underwent salvage oropharyngectomy at the University of Florida between 2016–2021 were identified from inpatient and outpatient records of the Head and Neck Oncology Team. Outcomes measured were tracheostomy dependence, tube-feed dependence, and intact oral intake status. Survival outcomes using Kaplan-Meier product limit method were calculated.

Results and Conclusion

Twenty-six patients were included in the analysis. Average age was 63.7 years. Fourteen (53.8 %) oropharyngectomies used a transmandibular approach, ten (38.5 %) through a combined transoral and transcervical approach, and two (7.7 %) through a transcervical approach. Average time to tracheostomy decannulation was 25.1 days. At 6 months, twenty (83.3 %) patients were gastric tube independent with twelve (54.2 %) patients tolerating any oral intake. At 12 months, gastric tube independent feeds decreased to nine (60 %) patients with thirteen (92.9 %) patients tolerating oral intake. The median overall survival was 27 months with local cancer recurrence being the most common cause of death.

Patients undergoing salvage oropharyngectomy for recurrent disease continue to face prolonged tracheostomy and tube dependent feedings. Despite intact swallowing function, patients preferred to use gastric tube feedings, likely for speed, ease, and convenience. Further studies are needed to analyze factors influencing these conflicting functional outcomes and predictive factors impacting survival.

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.