开放性喉部分切除术与全喉切除术治疗局部晚期（T3, T4）喉癌功能结局的回顾性比较

IF 3.3 4区医学 Q1 Medicine

European review for medical and pharmacological sciences Pub Date : 2025-06-01 DOI:10.26355/eurrev_202506_37271

J Pies, S Hackenberg, M Scheich, T Meyer, A Scherzad, M Goncalves

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引用次数: 0

摘要

目的：在不适合经口切除的病例中，开放性喉部分切除术（pLE）旨在提供肿瘤安全的切除，在不需要永久性气管切开术的情况下维持喉功能。在需要广泛切除的病例中，争论仍然存在，即pLE是否具有功能性结果，或者是否更适合全喉切除术（tLE）。材料和方法：本单中心回顾性队列研究评估了2010年11月至2023年8月间通过开放pLE或tLE行局部晚期（T3, T4）喉癌（LC）切除术的患者。排除经口切除，T1和T2病例。评估了气管切开术、口服喂养率、发声能力和肿瘤预后。结果：对38例le和56例tLEs的预后进行了评估。76%的ple患者（n=29/38）和47%的tLEs患者（n=26/56）接受辅助治疗。两种手术的肿瘤结果具有可比性(阴性边缘：p = 0.349；5年总生存率：p = 0.421)，全喉切除术（tLE）获得了更好的功能结局。术后吞咽能力明显改善（pLE vs tLE: 39.5% vs 91%, p < 0.001），特别是T4肿瘤患者（pLE vs tLE: 14% vs 89%, p < 0.001）和65岁以上患者(pLE vs tLE: 14% vs 100%；P < 0.001)。总体而言，误吸是pLE治疗后最常见的并发症，58%的病例（22/38）无法单独口服。26% （n=10/38）的ple患者气管切开术成功，中位时间为6.57个月（0.6-24个月）。因此，在pLE后，74% （n=28/38）的患者在中位随访4年期间保留了气管切开术。结论：与tLE相比，pLE术后气管吻合率低、中位4年口服喂养率低、T4肿瘤R0切除率低，提示局部晚期LC患者更适合tLE。图形摘要：https://www.europeanreview.org/wp/wp-content/uploads/Graphical-Abstract-NEW-1.jpg。

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Retrospective comparison of functional outcomes in open partial laryngectomy vs. total laryngectomyfor locally advanced (T3, T4) laryngeal cancer.

OBJECTIVE: Open partial laryngectomy (pLE), in cases not suited for transoral resection, aims to provide an oncologically safe resection, maintaining laryngeal function without the need for permanent tracheostomy. In cases requiring extensive resection, debate remains about whether pLE is feasible with a functional outcome or if total laryngectomy (tLE) is preferable. MATERIALS AND METHODS: This monocentric retrospective cohort study evaluated the resection of locally advanced (T3, T4) laryngeal carcinoma (LC) performed via open pLE or tLE between November 2010 and August 2023. Transoral resections, T1 and T2 cases were excluded. The presence of tracheostomy, the rate of oral feeding, the ability to phonate, and the oncologic outcome were assessed. RESULTS: The outcome of 38 pLEs and 56 tLEs was assessed. Adjuvant therapy was administered in 76% (n=29/38) pLEs and 47% (n=26/56) tLEs. While the oncologic results remained comparable between the two procedures (negative margins: p = 0.349; 5-year overall survival: p = 0.421), total laryngectomy (tLE) achieved better functional outcomes. Swallowing ability was markedly better after tLE (pLE vs. tLE: 39.5% vs. 91%, p < 0.001), particularly in patients with T4 tumors (pLE vs. tLE: 14% vs. 89%, p < 0.001) and in those over 65 years (pLE vs. tLE: 14% vs. 100%; p < 0.001). Overall, aspiration was the most frequent post-therapeutic complication after pLE, preventing unassisted oral intake in 58% of cases (22/38). The tracheostomy could be closed in 26% (n=10/38) of pLE-patients, at a median of 6.57 months (range 0.6-24 months). Consequently, after pLE 74% (n=28/38) of patients retained their tracheostomy at a median follow-up of 4 years. CONCLUSIONS: The low rates of tracheostoma closure, low rates of oral feeding over a median of 4 years, and R0 resection status of T4 tumors after pLE compared to tLE suggest patients with locally advanced LC are better suited for tLE.

Graphical abstract: https://www.europeanreview.org/wp/wp-content/uploads/Graphical-Abstract-NEW-1.jpg.

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来源期刊

European review for medical and pharmacological sciences 医学-药学

CiteScore

5.30

自引率

6.10%

发文量

906

审稿时长

2-4 weeks

期刊介绍： European Review for Medical and Pharmacological Sciences, a fortnightly journal, acts as an information exchange tool on several aspects of medical and pharmacological sciences. It publishes reviews, original articles, and results from original research. The purposes of the Journal are to encourage interdisciplinary discussions and to contribute to the advancement of medicine. European Review for Medical and Pharmacological Sciences includes: -Editorials- Reviews- Original articles- Trials- Brief communications- Case reports (only if of particular interest and accompanied by a short review)