喉癌治疗后原发灶复发的手术救援

Surgical salvage for the primary recurrence of laryngeal cancer

目的 总结治疗后原发灶复发的喉癌病例 ,探讨与手术挽救相关的问题。方法 回顾 1990 1995年于中山大学肿瘤防治中心住院治疗的 2 78例喉癌病例 ,对 2 8例治疗后出现原发灶复发的病例进行总结分析。出现复发后进行手术挽救 13例 ,其中行部分喉手术挽救 5例、行全喉切除术挽救 6例、其余 2例行复发肿物局部广泛切除。另外 15例中进行化疗 12例 (包括DBF方案 5例、DDP +BLM 1例、其余 6例行FT 2 0 7姑息化疗 )、进行放疗挽救 2例 (放疗剂量分别为 4 0和 5 0Gy)、另外 1例复发后未进行挽救治疗。结果 本组 2 8例原发灶复发的喉癌病例再次治疗后总体的 5年累计生存率为 4 0 .3%。手术挽救组和非手术挽救组的 5年生存率分别为 6 1.5 % (8/13)和 6 .7% (1/15 ) ,具有显著差异 (LogRank =13.72 ,P =0 .0 0 0 2 )。 13例进行手术挽救的病例中 3例再次复发 ,手术挽救的成功率为 6 9.2 % ,其中部分喉手术挽救和全喉切除术挽救的成功率分别为6 0 %和 83.3% ,统计学无显著性差异 (P =0 .5 4 5 )。患者的年龄、病变分期、病变部位、鳞癌分化程度、首次治疗方式、放疗以及复发间隔时间等因素不影响原发灶复发后手术挽救的进行。本组手术挽救的 13例病例中出现术后并发症 5例 ,约为 38.5 %。

Objective To investigate the primary recurrence of laryngeal cancer and to discuss some problems about surgical salvage. Methods 278 patients with laryngeal cancer hospitalized in Cancer Center of Zhong Shan University from 1990 to 1995 were reviewed. 28 patients presented primary recurrence after first treatment was analyzed. 13 patients with cancer recurrence were salvaged by surgery, including 5 of partial laryngectomy, 6 of total laryngectomy and the other 2 of local wide resection. Among the other 15 with non-surgical salvage, 12 underwent chemotherapy (including 5 with DBF, 1 with DDP plus BLM and 6 with FT-207), 2 cases underwent radiotherapy (dose 40 and 50 Gy) and 1 refused salvage. Results The 5-year cumulative survival in 28 with primary recurrence after salvage was 40.3%. The 5-year survival in surgical and non-surgical group was 61.5%(8/13)and 6.7%(1/15) respectively, (Log Rank=13.72, P=0.0002). 3 out of 13 with surgical salvage had second relapse. The successful surgical salvage rate was 69.2%. There was no significant difference between the partial and total laryngectomy in the successful surgical salvage rate(60% vs 83.3%, P=0.545). The age, stage, local site, pathological differentiation, the first treatment modality, radiotherapy and relapse time interval were not the influential factors to the availability of salvage surgery. 38.5%(5/13) with surgical salvage had complications after surgery. Conclusion There was better prognosis in surgical salvaged patients with primary recurrence of laryngeal cancer. Surgical salvage was the better choice for primary recurrence. Partial laryngectomy had the same successful salvage rate with total laryngectomy.