喉癌、下咽癌复发的临床分析和治疗转归

目的探讨喉癌、下咽癌术后复发的原因及挽救性手术的可行性.方法回顾分析98例复发性喉癌、下咽癌的临床资料.68例行癌复发手术切除及术后常规放疗,其中喉部分切除术后局部复发21例,颈淋巴结转移7例,局部复发并颈淋巴结转移5例;全喉切除术后气管造瘘口复发癌8例;下咽癌切除术后局部复发2例,颈淋巴结转移15例;30例行单纯放疗或姑息性治疗.68例行癌切除术和(或)改良根治性颈清扫术,其中胸大肌皮瓣修补术29例,胃上提代食管下咽15例,游离结肠上徙代下咽食管2例.结果喉癌手术后1年、3年生存率分别为96.10%和33.33%,下咽癌手术后1年、3年生存率分别为64.71%和5.88%,而单纯放疗或姑息治疗1年及3年的生存率仅为10%和0%.结论复发性喉癌、下咽癌的预后较差,适当的手术治疗可延长患者生命,提高生存质量.     

喉疣状癌的诊断与治疗(3例报告及文献复习)

目的 探讨喉疣状癌的诊断与治疗。方法对 3例喉疣状癌的临床、病理、诊断、治疗及预后进行回顾性分析。结果 3例喉疣状癌患者均为男性, 年龄 51 ~59岁, 平均年龄 56岁。喉疣状癌诊断较困难, 应反复多次活检才能确诊。其中 1例先后进行两次手术、1次放疗,终因肿瘤复发、组织间变、淋巴转移、肺感染、吞咽梗阻致全身衰竭死亡。2例行喉垂直部分切除术, 随访 5 ~6年无复发。结论　喉疣状癌容易误诊, 追踪观察肿瘤生长方式、外观形态和病理学检查可确诊。喉疣状癌以手术治疗为主, 切除力求彻底, 手术方式首选喉垂直部分切除术。放射治疗不敏感。     

喉小涎腺癌15例临床分析

目的 探讨喉小涎腺癌的临床特点、治疗及预后.方法 回顾性分析中国医学科学院肿瘤医院头颈外科1959至2005年收治的15例喉小涎腺癌患者的临床资料.11例(73.3%)病变位于声门上区,4例(26.7%)病变位于声门下区.其中腺样囊性癌10例,腺癌2例,黏液表皮样癌、恶性混合瘤、基底细胞腺癌各1例.单独手术7例;手术+放疗7例,其中6例患者行术后放疗,1例行术前放疗;1例行放疗+化疗.治疗后4例局部复发患者行手术挽救,其中l例肺转移后行转移灶切除;1例治疗后颈转移患者行放疗.结果 随访时间2～16年,中位数为8年.治疗后局部复发4例次,颈淋巴转移1例次,远处转移5例次,其中局部复发伴远处转移3例.7例患者存活3～16年,其中5例为无瘤生存,1例行单纯手术治疗,4例行手术+放疗;4例远处转移于治疗2～10年后死亡;其余4例随访2～16年后失访.结论 喉小涎腺癌很少见,其易发生局部复发和远处转移,远处转移是最主要的死亡原因.外科手术是喉小涎腺癌的主要治疗方法 ,手术结合放疗可望提高肿瘤局部控制率.     

112例T3期喉癌扩大喉部分切除和喉全切除术的疗效分析

目的:探讨T3期扩大喉部分切除和喉全切除术的疗效.方法:于1984年1月至1996年5月对112例T3期喉癌的临床资料进行回顾性分析,其中行扩大喉部分切除术48例(单纯手术29例,手术加放疗19例);喉全切除术64例(单纯手术39例,手术加放疗法25例).结果:喉部分切除术组和喉全切除术组3年和5年生存率分别为77.1%、66.7%和97.7%、71.1%;各组单纯手术和手术加放疗的3年和5年生存率比较,喉部分切除组分别为75.7%、65.0%和78.9%、69.2%;喉全切除组分别为81.2%、71.4%和76.0%、70.6%,各组3年和5年生存率均无显著性差异(P＞0.05).结论:T3期喉癌只要掌握好喉部分切除术的适应证,其疗效与喉全切除术接近;术后放疗不能减少局部和颈部癌复发的危险.     

喉神经内分泌癌临床分析

目的　探讨喉神经内分泌癌的诊断、治疗及预后情况。方法　回顾性分析重庆医科大学附属第一医院耳鼻咽喉科2006年～2012年收治的6例喉神经内分泌癌患者 的临床资料。结果　随访时间3～54个月。1例典型类癌就诊时发现颈椎转移,未治疗随访13个月后死亡;2例非典型类癌,1例手术联合放化疗治疗后23个月未见复发转移,另1例单纯放疗后34个月后出现局部复发,行手术挽救性治疗后20个月肺转移及骨转移;3例小细胞神经内分泌癌,1例行放化疗后10个月局部复发,手术挽救性治疗后5个月远处转移死亡,另2例行放化疗后4个月及17个月远处转移死亡。结论  喉神经内分泌癌很少见,预后差,极易复发转移,治疗方式 及预后情况与喉神经内分泌癌病理亚型密切相关。     

喉疣状癌的临床分析

目的：分析喉疣状癌的临床病理特点、手术方式和疗效。方法：经病理证实的喉疣状癌患者10例，5例行垂直半喉+重建术；2例行环状软骨上喉部分切除+环舌会厌吻合术（CHEP）；2例行支撑喉镜下YAG激光声带切除术，其中1例术后放疗，另1例4个月后原位复发，行垂直半喉+重建术后控制；1例行喉裂开声带切除术。结果：所有患者均恢复正常的呼吸和吞咽功能，9例插管患者拔除气管套管后均获得正常的发音功能。术后随访：1例患者原位复发，1例因其他部位肿瘤死亡，2例因心脑血管疾病死亡。全部患者手术部位癌细胞无远处转移，5年生存率75%。结论：喉疣状癌是高分化鳞状细胞癌的一种特殊类型，本病确诊有赖于病理专家与喉科医师密切配合。手术是喉疣状癌主要的治疗方式，在切除肿瘤的基础上保留喉功能，提高患者生活质量     

全喉切除术后气管造口复发癌

目的 探讨喉癌、下咽癌全喉切除术后气管造口复发癌病因、诊断及治疗，提出气管造口复发癌预防措施。方法 回顾性分析16例喉癌、下咽癌全喉切除术后气管造口复发癌临床资料，对比手术和非手术治疗的效果。结果 16例气管造口复发癌全喉切除术前均有肿瘤声门下侵犯，5例术后绝缘阳性；手术治疗11例，5例术后病理证实为淋巴结转移；术后生存5－68个月，4例（4／9）存活3年以上；放射治疗或未治疗5例，生存3－7个月；手术明显延长生命（P＜0．01）。结论 气管造口复发癌病因可能与肿瘤残存、种植、淋巴结转移、肿瘤分化有关；预后差，应重在预防。全喉手术肿瘤的彻底切除，标本切缘的显微监控，精细的颈淋巴清扫手术是降低本病发生率的重要保证。     

声门下癌的临床及其手术治疗

目的 探讨声门下癌的临床特点、手术和重建喉功能的方法及喉声门下部分切除术的可行性。方法 总结 １９８１￣１９９７年声门下癌１３例,Ｔ１－２Ｎｏ６例,Ｔ３Ｎｏ１例,Ｔ３－４Ｎ１－２６例。４例行全喉切除术,９例行喉声门下部分切除术和扩大喉声门下部分切除术（累及气管者）,分别以单侧或双侧皮瓣、肌筋膜瓣整复,喉腔内置“Ｔ”型硅胶管扩张,２￣６个月拨除。其中６例行颈清扫术。结果 除４例全喉切除术者外,余９例     

复发性喉癌挽救性手术保留喉功能初步临床分析

目的 探讨复发性喉癌挽救性手术治疗保留喉功能的可行性.方法 通过对患者和肿瘤进行全面、细致的临床和影像学评估,合理选择手术方式及其适应证.对36例放疗、激光手术和开放式喉部分切除术后复发的喉癌患者,实施挽救性手术治疗同时保留喉功能.术后对所有患者进行正规随访,Kaplan-Meier法计算术后生存率.结果 实施经口激光二次肿瘤切除术4例,喉水平部分切除4例,喉垂直部分切除术13例,环状软骨上切除术(Majer-Piquet)手术15例,18例患者同时接受了颈清扫术.术后6例患者发生不同程度的并发症,其中主要是局部感染和咽瘘,没有院内死亡和其他严重并发症发生.5例术后近期并发症均经适当处理后治愈,1例接受喉垂直部分切除术的喉裂开肿瘤切除术后复发患者因切缘病理阳性接受术后放疗,导致喉狭窄及喉腔闭塞失去喉发音和呼吸功能.术后肿瘤局部复发5例,局部和颈部同时复发1例,肿瘤局部控制率为83.3％(30/36).术后3年生存率80.6％,死亡原因分别为肿瘤复发3例,远处转移3例,其他非肿瘤原因(心脏病)1例.结论 初步临床观察表明,对于喉癌治疗后早期和局限性复发的患者,在对肿瘤进行全面细致评估和严格把握手术适应证的基础上,可以选择性实施保留喉功能的挽救性外科手术,从而提高这类肿瘤患者的生存质量.     

喉声门型癌Ⅲ期病变临床治疗

目的比较不同治疗方案对喉声门型癌T3N0M0病变预后的影响,优化临床治疗.方法分析1992年～1999年我院采用喉垂直部分切除术、喉全切除术和根治性放射治疗等方案治疗的65例喉声门型癌T3N0M0病变的临床资料,比较不同治疗的总体生存率、原发部位及颈部淋巴结复发率和喉功能保留率.结果Cox分析显示三种治疗方案的总体生存率、原发部位和颈部淋巴结复发率无显著性差异（P＞0.05）;喉垂直部分切除术和根治性放射治疗的喉功能保存率高,差异有显著性（P＜0.01）.结论三种方案治疗喉声门型癌T3N0M0病变,总体生存率和复发率无差异,喉垂直部分切除术和根治性放疗有利于保留喉功能.     

复发性喉癌的外科挽救治疗

目的：探讨喉癌复发患者采用手术治疗的疗效及预后。方法：采用挽救性手术治疗43例复发喉癌患者。采用Kaplan-Meier法计算生存率,Log-rank检验单因素分析临床因素对预后的影响。结果：挽救术后并发症为23.3%（10/43）,其中感染及咽瘘发生率18.6%（8/43）。挽救手术后随访满3年有32例患者,3年生存率为56.3%,满5年有25例患者,5年生存率为32.0%,首诊分期与3年生存率相关（P〈0.05）。喉内复发组及喉功能保留组预后较好,但差异无统计学意义。结论：挽救性手术是复发性喉癌较好的治疗方法,其预后与首诊分期相关,对局部复发的喉癌患者选择性保留喉功能可获得较好的疗效及预后。     

Salvage surgery after failure of nonsurgical therapy for carcinoma of the larynx and hypopharynx

BACKGROUND: For larynx preservation, radiotherapy is gaining popularity for primary treatment of laryngeal and hypopharyngeal cancer, reserving surgery for salvage. OBJECTIVE: To analyze the outcome of salvage surgery after failure of primary radiotherapy. DESIGN: Nine-year retrospective outcome analysis. SETTING: University referral center. PATIENTS: Fifty-four patients with squamous cell carcinoma of the larynx (n = 39) or hypopharynx (n = 15). RESULTS: For laryngeal cancer, mean interval from radiation to detection of recurrence was 14.5 months (range, 2-66 months). Twenty-three patients (59%) presented with a more advanced tumor stage after radiation than at the initial evaluation. Total laryngectomy was needed in 36 patients (92%). Disease-specific 5-year survival rate was 63%. Survival of patients with small recurrent tumors was statistically significantly better than those with advanced tumors (P =.004). For hypopharyngeal cancer, mean interval from radiation to detection of the recurrence was 10.6 months (range, 3-40 months). Total laryngopharyngectomy was needed in 8 of 9 patients with local recurrrence; neck dissection, in 6 patients with regional recurrence. Disease-specific 5-year survival rate was only 20%. Recurrent tumor and node stages did not influence the outcome. Patients with regional recurrences did no better than those with local ones. CONCLUSIONS: Salvage surgery in laryngeal cancer achieves good results, especially for small recurrences. Because of tumor progression, larynx preservation is seldom possible at the time of salvage. Salvage surgery in hypopharyngeal cancer shows poor survival regardless of tumor stage and despite radical surgical procedures, and can be recommended only for carefully selected patients. Arch Otolaryngol Head Neck Surg. 2000;126:1473-1477     

Partial laryngeal surgery in recurrent carcinoma

With the growing acceptance of nonsurgical therapies for laryngeal squamous cell carcinomas (LSCCs), it has become important to delineate surgical salvage strategies for disease recurrences. Total laryngectomy is often recommended, but appropriately selected laryngeal recurrences may be treated successfully with partial laryngeal surgery: laryngeal function can be preserved with oncological efficacy. The main available studies dealing with partial laryngeal surgery in recurrent carcinoma were critically reviewed. The most appealing feature of salvage transoral laser surgery (TLS) is the opportunity to make tumor-tailored excisions without any reconstructive limitations and retaining the option to switch to open partial laryngectomy. A recent detailed review of 11 series found a pooled local control rate of 57% after a first TLS procedure. Supracricoid laryngectomy (SCL) seems to achieve good local control rates in selected cases of recurrent supraglottic-glottic carcinoma: one review considering seven series calculated that 85% of the patients treated with salvage SCL after radiotherapy experienced no local recurrence; and total laryngectomy after failure of salvage SCL afforded an overall local control rate of 65%. Neck dissection is mandatory in all cases of local LSCC recurrence with evidence of neck metastases, and routine elective neck dissection is recommended for recurrent supraglottic and transglottic cancers.     

Supracricoid Partial Laryngectomy After Failed Laryngeal Radiation Therapy

Twelve patients managed with supracricoid partial laryngectomies(SCPLs) after failed laryngeal radiation therapy (RT) were evaluated. None of the recurrent tumors were amenable to vertical or horizontal partial laryngectomy. Results were analyzed for tracheostomy decannulation, oral alimentation, morbidity, local control, and survival. Major complications included perichondritis (2 patients), laryngeal stenosis (2 patients), and pneumonia from aspiration (1 patient). Mucocutaneous fistula and cricoarytenoid joint ankylosis were not encountered. Margins of resection were uninvolved in all cases. The Kaplan-Meier 3-year actuarial survival and local control estimate was 83.3%. Salvage total laryngectomy allowed for an overall 100% local control rate and a 75% laryngeal preservation rate. This preliminary report suggests that, in patients with failed laryngeal RT not amenable to vertical or horizontal partial laryngectomy, the SCPL procedures should be discussed before advocating salvage total laryngectomy. Further series analyzing the role and limitations of the various SCPL procedures after failed laryngeal RT are warranted.     

Salvage surgery after induction chemotherapy with paclitaxel/cisplatin and primary radiotherapy for advanced laryngeal and hypopharyngeal carcinomas

Induction chemotherapy followed by primary radiotherapy in responders is considered an alternative to surgery for advanced cancer of the larynx and hypopharynx (LHC). Comparison of therapeutic approaches is challenging and must respect oncological and functional outcome as well as quality of life during and after treatment. One aspect of primary radiochemotherapy is the option of salvage surgery in case of residual tumor. The outcome after salvage surgery following new organ-preserving strategies has to be examined. All patients undergoing induction chemotherapy with paclitaxel and cisplatin followed by radiotherapy from 01/96 to 07/05 were included. Salvage surgery was performed either for local recurrence or suspected persistent nodal disease. Complete tumor removal, perioperative morbidity, and overall survival were analyzed in a retrospective study. 28 out of 134 patients underwent salvage surgery after primary treatment with induction chemotherapy and radiotherapy for advanced LHC. 15 patients had laryngectomy (LE) with neck dissection (ND), while 1 patient had lasersurgical partial laryngeal resection with ND for local recurrences. Twelve patients had salvage ND for suspicion of persistent lymph node metastases. 73% of LE patients had major postoperative problems such as pharyngocutaneous fistulas. In 56% of the cases, tumor removal turned out to be microscopically incomplete. Eight out of 12 patients who underwent salvage ND because of suspicious lymph nodes (66%) were free of vital tumor. When metastatic disease was present in the neck (4/12), recurrences occurred in 75% during postoperative follow-up. Only 2 out of 20 patients undergoing surgery for histologically proven recurrence after radiochemotherapy (10%) are actually tumor-free and alive after a mean observation time of 43.9 months. Salvage surgery for local recurrence is associated with high morbidity and poor oncological and functional outcome. ND for suspicious persistent nodal disease after radiochemotherapy can be an over-treatment. In our patients, it was burdened with cervical recurrences and distant metastases in presence of histologically confirmed lymph node metastases. In the light of our results, unfavourable outcome after salvage surgery must be pointed out when initially informing patients about different therapeutic options for advanced LHC.     

Supracricoid partial laryngectomy with cricohyoidoepiglottopexy and cricohyoidopexy for glottic and supraglottic carcinomas

OBJECTIVES: To review the patients operated in our department with supracricoid partial laryngectomy with either cricohyoidoepiglottopexy (CHEP) (59 cases) or cricohyoidopexy (CHP) (10 cases) technique, for primary or recurrent glottosupraglottic squamous cell carcinoma and compare the technique with other surgical or conservative approaches for treatment of laryngeal carcinoma. METHODS: From hospital charts, we retrospectively reviewed 69 patients who had undergone supracricoid partial laryngectomy with the CHEP or CHP technique between 1983 and 1996 for primary or recurrent glottosupraglottic squamous cell carcinoma in our department. Statistical evaluation of oncological and functional results were conducted. Results were compared with other surgical and conservative treatment for glottosupraglottic carcinoma of the larynx that were published previously in the literature. RESULTS: Sixty-nine patients had CHEP or CHP for glottosupraglottic carcinoma of the larynx. Thirteen percent of the patients received adjuvant radiotherapy. Minimum follow-up was 2 years or until death. Five-year actuarial survival (Kaplan-Meier method) was 68%. Global local control was achieved in 84% of cases. Among previously untreated patients (n = 54), local control rate was 94.5%. After 1 year, 92.7% of patients achieved normal swallowing and respiration. Salvage total laryngectomy had to be performed in four patients (5.7%) for persistent aspiration and in five patients (7.2%), who were previously treated with radiotherapy, for local recurrence. No permanent tracheostomy or gastrostomy was required. CONCLUSIONS: Our experience with supracricoid partial laryngectomy with either CHP or CHEP suggests that this technique is a valuable alternative to radiotherapy for T2-T4 glottosupraglottic carcinomas, particularly those with extension and invasion of the anterior commissure. It allows for preservation of a good laryngeal function without altering the long-term survival, keeping total laryngectomy as a salvage procedure.     

Oncologic and functional outcomes of salvage supracricoid partial laryngectomy

Abstract

Background: Supracricoid partial laryngectomy (SCL) can have a positive impact on patients’ quality of life by circumventing dysphagia and voice problems resulting from creation of a permanent stoma after conventional total laryngectomy (TL) surgery.

Aims/Objectives: The aim of this study was to investigate the oncologic and functional outcomes of salvage SCL for recurrent laryngeal carcinoma.

Material and methods: Forty-five patients that underwent salvage surgery for recurrent laryngeal carcinoma between January 2004 and May 2015 after initial treatment failure were included in this retrospective study.

Results: Overall survival and disease free survival were non-significantly higher in the salvage SCL group (n?=?14) than in the salvage TL group (n?=?31) (87.5 versus 56.5%, 53.4 versus 41.9%). Multivariate analyses showed only positive resection margin to be significantly associated with survival and recurrence (HR 9.974, p?=?.007, and HR 9.196, p?=?.002, respectively). In the salvage SCL group, 92.8% achieved successful decannulation and all patients returned to an oral diet. All patients in the salvage TL group sustained a permanent stoma and conversation was possible only through esophageal voice or a voice prosthesis. 74.2% of patients in the group were able to tolerate an oral diet.

Conclusions and significance: Salvage SCL showed comparable oncologic outcomes and favorable functional outcomes relative to the classic salvage TL. This study could provide a sufficient basis of SCL as salvage treatment for recurrent laryngeal carcinoma in selected patients.     

Results of surgical treatment alone for primary subglottic carcinoma

Primary subglottic carcinoma is rare and surgery is the most common therapeutic strategy for Chinese patients with this disease. To retrospectively evaluate surgically treated primary subglottic carcinoma treated with surgery. Patients with primary subglottic carcinoma who initially underwent surgery from 2005-2010 were grouped by surgical procedures with or without laryngeal function preservation and reviewed. Of 1815 patients with laryngeal cancer, 23 had a subglottic origin. Of these, 21 initially underwent surgery; 12 had ‘early’ (stage I/II) disease, and nine had ‘advanced’ (stage III/IV) disease. The actuarial 5-year OS was 73.9% [95% confidence interval (54.1% ～ 93.7%)] for patients with squamous cell carcinoma. Among patients with early disease, the 5-year OS and DFS were 80% for partial laryngectomy and 71.4% for total laryngectomy. Patients with advanced disease underwent total laryngectomy, and the 5-year OS and DFS were 62.5%. Satisfactory oncologic outcomes can be achieved with initial surgery. Patients with early disease who underwent partial laryngectomy had a comparable prognosis to those who underwent total laryngectomy; deglutition and speech function were maintained.     

Salvage surgery after radiotherapy for laryngeal cancer: from endoscopic resections to open-neck partial and total laryngectomies

OBJECTIVE: To evaluate our experience in management of radiotherapy failure using endoscopic resection (ER) with carbon dioxide laser, open-neck partial laryngectomy (ONPL), and total laryngectomy. DESIGN: Retrospective medical record review. SETTING: Referral university hospital. PATIENTS: Seventy-one patients with laryngeal cancer previously treated with radiotherapy (69 patients) and chemoradiotherapy (2 patients) underwent salvage surgery. INTERVENTIONS: The treatment policy encompassed ER for glottic rT1a, rT1b with limited anterior commissure involvement, and rT2 with normal cord mobility carcinoma. All ONPLs were performed for rT1 and rT2 tumors with suboptimal endoscopic exposure, rT2 tumors with impaired cord mobility or transcommissural extension, and rT3 tumors for limited paraglottic space invasion or involvement of the inner portion of the thyroid cartilage. Total laryngectomy was planned in patients who were not suitable for partial laryngectomy owing to poor general condition, for rT3 carcinoma with massive involvement of the paraglottic space, and for rT4a tumors. MAIN OUTCOME MEASURES: Clinical, radiologic, surgical, and pathologic data. Survival curves were calculated using the Kaplan-Meier method. Comparisons between different variables were performed using the log-rank test. RESULTS: Salvage surgery consisted of ER in 22 patients, ONPL in 15, and total laryngectomy in 34. The pT category after salvage surgery was pT1 in 12 patients, pT2 in 20, pT3 in 20, and pT4a in 19. Five-year disease-specific and disease-free survival and laryngeal preservation for the entire series were 72%, 61%, and 40%, respectively. CONCLUSIONS: Survival rates for the entire series were not different from those previously reported using a more aggressive surgical approach without attempts at organ preservation. The laryngeal preservation rate justifies conservative treatment in the presence of limited recurrent lesions.     

Early vocal cord carcinoma in obese patients: A surgical lesion

Early epidermoid carcinoma of the vocal cord is treated successfully by radiation therapy with high 5-year survival rates, low morbidity, and preservation of excellent voice quality in most cases. Typically, surgery is reserved for salvage of radiation failure and provides overall 5-year survival rates of 98% and 90% for T1 and T2 lesions, respectively. The extremely obese patient, often with a short neck and excessive amounts of subcutaneous fat, is difficult for both radiotherapist and surgeon to diagnose and treat. The recent observation of an unusually high rate of radiotherapy failure in a cluster of obese patients with early vocal cord cancer called attention to this problem. Because the larynx is near the thoracic inlet in obese patients, they are not suitable for administration of radiotherapy by accurate opposed lateral portals. The patients reported herein were treated entirely with anterior oblique portals. Of the five obese patients who underwent primary radiation therapy for early vocal cord cancer, three developed recurrent disease (60%) and a fourth developed a severe perichondritis requiring tracheostomy. Two patients with recurrent disease were successfully salvaged with total laryngectomy, while the third patient refused surgery and died 2 years later. The sixth patient was treated by partial laryngectomy with imbrication reconstruction and is alive and without evidence of disease 2 years following surgery. Recurrence rates and complication rates following primary radiation therapy for early vocal cord cancer appear to be unacceptably high in obese patients treated with anterior oblique portals. Therefore, we recommend primary conservation laryngeal surgery for obese patients with early vocal cancer who cannot undergo “standard” radiotherapeutic techniques.