PDF(Pubmed)
Abstract：
BACKGROUND: Tracheoesophageal shunt insufficiency (TESI) is a common and potentially life-threatening complication after laryn(-gopharyn)gectomy (L(P)E). We investigated whether TESI could be the result of a specific shunt location.
METHODS: A monocentric, retrospective cohort analysis of 171 consecutively treated L(P)E patients was performed. Patients with a secondary prosthesis instillation and patients with insufficient postoperative imaging were excluded. Disease related data as well as location of primary voice prosthesis were assessed.
RESULTS: The cohort was divided into 62 TESI-positive and 109 TESI-negative individuals. The mean time from surgery to TESI was 32 months. No differences were observed in gender, age, tumor localization, T/R/M-status. Surgery without adjuvant therapy was more often performed in TESI-negative individuals when compared with their positive counterparts. However, Cox regression including T/N status, therapy and categorized distance of the tracheoesophageal shunt to the manubrium (≤1.5 cm vs. >1.5 cm) revealed that a distance of ≤1.5 cm was associated with a 2.1-fold increased risk of TESI, while all other parameters did not influence the event-free survival.
CONCLUSIONS: Primary shunt positioning ≤1.5 cm to the ridge of the manubrium is associated with an increased risk of TESI. In these individuals secondary shunt operation resulting in a position >1.5 cm distant to the manubrium should be recommended.
METHODS: A monocentric, retrospective cohort analysis of 171 consecutively treated L(P)E patients was performed. Patients with a secondary prosthesis instillation and patients with insufficient postoperative imaging were excluded. Disease related data as well as location of primary voice prosthesis were assessed.
RESULTS: The cohort was divided into 62 TESI-positive and 109 TESI-negative individuals. The mean time from surgery to TESI was 32 months. No differences were observed in gender, age, tumor localization, T/R/M-status. Surgery without adjuvant therapy was more often performed in TESI-negative individuals when compared with their positive counterparts. However, Cox regression including T/N status, therapy and categorized distance of the tracheoesophageal shunt to the manubrium (≤1.5 cm vs. >1.5 cm) revealed that a distance of ≤1.5 cm was associated with a 2.1-fold increased risk of TESI, while all other parameters did not influence the event-free survival.
CONCLUSIONS: Primary shunt positioning ≤1.5 cm to the ridge of the manubrium is associated with an increased risk of TESI. In these individuals secondary shunt operation resulting in a position >1.5 cm distant to the manubrium should be recommended.
摘要：
背景：气管食管分流功能不全（TESI）是喉癌（咽喉）切除术（L（P）E）后常见且可能危及生命的并发症。我们调查了TESI是否可能是特定分流位置的结果。
方法：单中心，对171例连续治疗的L(P)E患者进行回顾性队列分析.排除二次假体滴注的患者和术后影像学不足的患者。评估疾病相关数据以及主要语音假体的位置。
结果：该队列分为62名TESI阳性和109名TESI阴性个体。从手术到TESI的平均时间为32个月。没有观察到性别差异，年龄,肿瘤定位，T/R/M状态。与TESI阴性个体相比，没有辅助治疗的手术更常见。然而,Cox回归包括T/N状态，治疗和气管食管分流管到支架的分类距离(≤1.5cmvs.>1.5cm）表明≤1.5cm的距离与TESI的风险增加2.1倍相关，而所有其他参数均不影响无事件生存率.
结论：初级分流定位在距柄脊≤1.5cm处与TESI风险增加相关。在这些个人中，应建议进行二次分流手术，以使位置与支架相距>1.5cm。
方法：单中心，对171例连续治疗的L(P)E患者进行回顾性队列分析.排除二次假体滴注的患者和术后影像学不足的患者。评估疾病相关数据以及主要语音假体的位置。
结果：该队列分为62名TESI阳性和109名TESI阴性个体。从手术到TESI的平均时间为32个月。没有观察到性别差异，年龄,肿瘤定位，T/R/M状态。与TESI阴性个体相比，没有辅助治疗的手术更常见。然而,Cox回归包括T/N状态，治疗和气管食管分流管到支架的分类距离(≤1.5cmvs.>1.5cm）表明≤1.5cm的距离与TESI的风险增加2.1倍相关，而所有其他参数均不影响无事件生存率.
结论：初级分流定位在距柄脊≤1.5cm处与TESI风险增加相关。在这些个人中，应建议进行二次分流手术，以使位置与支架相距>1.5cm。
