目的:复发性口咽癌患者可以通过手术抢救获得生存益处,通常需要同时进行游离皮瓣重建。切除和重建会影响功能,导致管依赖。
目的:描述口咽切除术后气管造口术和胃造瘘管依赖率,以及预先放疗后的游离皮瓣。
目的:评估患者,肿瘤,以及与管依赖相关的治疗因素。
方法:回顾性,多机构队列研究。从2003年到2020年接受治疗的患者。平均随访21.4个月。
方法:五个三级护理中心。
方法:接受头颈部放疗后口咽鳞状细胞癌切除和同时游离皮瓣重建的连续队列患者。
方法:胃造瘘管依赖性和术后1年气管造口术或气管造口术。进行单变量和多变量逻辑回归以确定与依赖相关的因素。
结果:89例患者接受了口咽切除术和游离皮瓣重建;18例(20%)接受了全喉切除术作为肿瘤摘除的一部分。手术后,51例(57%)患者存活12个月。在12个月时还活着的患者中,22例(43%)至少部分依赖于胃造瘘管,15例(29%)进行了气管造口术或气管造口术。在多变量分析中,广泛舌状切除术(OR16.6,95%CI1.83-389,p=0.026)和全喉切除术(OR11.2,95%CI1.71-105,p=0.018)与长期胃造瘘管相关.在多变量分析中,没有因素与长期气管造口术相关。
结论:即使在抢救切除和游离皮瓣重建后的长期幸存者中,管依赖性率显着。这项多机构审查是迄今为止规模最大的此类研究,可能有助于为共同决策提供信息。
方法:IV喉镜,2022年。
Patients with recurrent oropharyngeal cancer can achieve survival benefits from surgical salvage, and often require simultaneous free-flap reconstruction. Resection and reconstruction can impact function, leading to tube dependence.
describe rates of tracheostomy and gastrostomy tube dependence after oropharyngeal resection and free flap after prior radiation.
evaluate patient, tumor, and treatment factors associated with tube dependence.
Retrospective, multi-institutional cohort study. Patients treated from 2003 to 2020. Average follow-up 21.4 months.
Five tertiary care centers.
Consecutive cohort of patients undergoing resection and simultaneous free-flap reconstruction for oropharyngeal squamous cell carcinoma after head and neck radiation.
gastrostomy tube dependence and tracheostomy or tracheostoma 1 year after surgery. Univariable and multivariable logistic regression were performed to identify factors associated with dependence.
89 patients underwent oropharyngectomy and free-flap reconstruction; 18 (20%) underwent total laryngectomy as part of tumor extirpation. After surgery, 51 patients (57%) lived 12 months. Among patients alive at 12 months, 22 (43%) were at least partially-dependent on gastrostomy tube, and 15 (29%) had either tracheostomy or tracheostoma. On multivariable analysis, extensive glossectomy (OR 16.6, 95% CI 1.83-389, p = 0.026) and total laryngectomy (OR 11.2, 95% CI 1.71-105, p = 0.018) were associated with long-term gastrostomy tube. No factors were associated with long-term tracheostomy on multivariable analysis.
Even among long-term survivors after salvage resection and free-flap reconstruction, rates of tube dependence are significant. This multi-institutional review is the largest such study to the date and may help inform shared decision-making.
4 Laryngoscope, 133:2141-2147, 2023.