Abstract：
OBJECTIVE: The study aimed to identify parameters that could predict oncological and functional outcomes in patients with pT4aN0 laryngeal squamous cell carcinoma (LSCC) who underwent open partial horizontal laryngectomy (OPHL). The role of paratracheal neck dissection (PTND) was analyzed as the primary outcome. Additionally, the study compared the outcomes of patients who underwent postoperative radio/chemotherapy (PORT/PORCT) with those who refused or did not adhere to adjuvant treatments.
METHODS: Twenty-nine OPHL patients whose pathological exam was consistent with pT4aN0-x disease were enrolled and their clinical charts were retrospectively reviewed. The study analyzed oncological outcomes, such as local, regional, and distant recurrence rates (RR), overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS). Additionally, functional results were analyzed, including decannulation rate, hospitalization time, and postoperative complication rate.
RESULTS: The study revealed and overall recurrence rate of 27%. The final rates for OS and DSS were 68% and 79%, respectively. Based on the univariate analysis the PTND was significantly associated with longer DFS. No significant differences inoncological outcomes were observed between pT4a patients who underwent adjuvant radio/radiochemotherapy and those who did not, in terms of RR, DFS, DSS or OS. However, adjuvant treatment was found to significantly increase decannulation time.
CONCLUSIONS: In a properly super-selected subgroup of patients with pT4aN0 LSCC, OPHL may beconsidered as a conservative surgical option even without adjuvant treatment. However, for optimal oncological outcomes, it is strongly recommended to consider a central compartment dissection in cases of hypoglottic and anterior extra-laryngeal tumor extension.
METHODS: Twenty-nine OPHL patients whose pathological exam was consistent with pT4aN0-x disease were enrolled and their clinical charts were retrospectively reviewed. The study analyzed oncological outcomes, such as local, regional, and distant recurrence rates (RR), overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS). Additionally, functional results were analyzed, including decannulation rate, hospitalization time, and postoperative complication rate.
RESULTS: The study revealed and overall recurrence rate of 27%. The final rates for OS and DSS were 68% and 79%, respectively. Based on the univariate analysis the PTND was significantly associated with longer DFS. No significant differences inoncological outcomes were observed between pT4a patients who underwent adjuvant radio/radiochemotherapy and those who did not, in terms of RR, DFS, DSS or OS. However, adjuvant treatment was found to significantly increase decannulation time.
CONCLUSIONS: In a properly super-selected subgroup of patients with pT4aN0 LSCC, OPHL may beconsidered as a conservative surgical option even without adjuvant treatment. However, for optimal oncological outcomes, it is strongly recommended to consider a central compartment dissection in cases of hypoglottic and anterior extra-laryngeal tumor extension.
摘要：
目的：本研究旨在确定可以预测pT4aN0喉鳞状细胞癌（LSCC）患者行开放式部分水平喉切除术（OPHL）的肿瘤和功能结局的参数。分析了气管旁颈部夹层（PTND）的作用作为主要结果。此外,本研究比较了接受术后放疗/化疗(PORT/PORCT)的患者和拒绝或不坚持辅助治疗的患者的结局.
方法：纳入病理检查符合pT4aN0-x疾病的29例OPHL患者，并回顾性分析其临床表现。这项研究分析了肿瘤的结果，如当地,区域,和远处复发率（RR），总生存期（OS），无病生存率（DFS），和疾病特异性生存（DSS）。此外,对功能结果进行了分析，包括拔管率，住院时间,术后并发症发生率。
结果：研究显示总复发率为27%。OS和DSS的最终比率分别为68%和79%，分别。根据单变量分析，PTND与较长的DFS显着相关。在接受辅助放疗/放化疗的pT4a患者和未接受辅助放疗/放化疗的pT4a患者之间，肿瘤学结果没有显着差异，就RR而言，DFS,DSS或操作系统。然而,发现辅助治疗可显着增加拔管时间。
结论：在一个适当超选择的pT4aN0LSCC患者亚组中，即使没有辅助治疗，OPHL也可能被认为是保守的手术选择。然而,为了获得最佳的肿瘤结果，强烈建议在声门减退和喉外肿瘤前段扩展的情况下考虑中央室夹层。
方法：纳入病理检查符合pT4aN0-x疾病的29例OPHL患者，并回顾性分析其临床表现。这项研究分析了肿瘤的结果，如当地,区域,和远处复发率（RR），总生存期（OS），无病生存率（DFS），和疾病特异性生存（DSS）。此外,对功能结果进行了分析，包括拔管率，住院时间,术后并发症发生率。
结果：研究显示总复发率为27%。OS和DSS的最终比率分别为68%和79%，分别。根据单变量分析，PTND与较长的DFS显着相关。在接受辅助放疗/放化疗的pT4a患者和未接受辅助放疗/放化疗的pT4a患者之间，肿瘤学结果没有显着差异，就RR而言，DFS,DSS或操作系统。然而,发现辅助治疗可显着增加拔管时间。
结论：在一个适当超选择的pT4aN0LSCC患者亚组中，即使没有辅助治疗，OPHL也可能被认为是保守的手术选择。然而,为了获得最佳的肿瘤结果，强烈建议在声门减退和喉外肿瘤前段扩展的情况下考虑中央室夹层。
