Objectives: To evaluate feasibility and efficacy of surgical approach of laryngofissure combined with epiglottis valley in treating locally-advanced pyriform sinus carcinoma.
Methods: Clinical data of 216 patients with T3 and T4a pyriform sinus carcinoma, who came from the Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University between January 2013 and December 2019, were retrospectively analyzed. Three different types of surgery were used in these patients. Seventy-three patients were performed by approach of laryngofissure combined with epiglottis valley for partial laryngopharyngectomy (Group I); 75 patients were performed by approach of lateral pharynx for piriform fossa resection (Group II); 68 patients were performed by total laryngopharyngectomy (Group III). All patients were treated with radiotherapy and followed up regularly after operation. Kaplan-Meier regression model was used to analyze the overall survival rate. EAT-10 swallowing scale was utilized to evaluate the postoperative swallowing function, while the rate of tracheal tube extubation and the incidence of postoperative complications in each group were compared.
Results: There were 76.7% patients with T3 stage in Group I, 100% patients with T3 stage in Group II, and 64.7% patients with T4a stage in Group III. There was significant difference between them (P<0.01). Clinical stage IV patients in the Group I, Group II, and Group III were 74.0%, 54.7%, and 89.7%, respectively, with significant difference (P<0.01). The 3-year overall survival (OS) rate in Group I, Group II, and Group III were 69.9%, 53.3%, and 58.8%, respectively. Patients in the Group I had a better survival outcome than that in the Group II (P<0.05). The median score of EAT-10 swallowing scale was 12.0 in the Group I, 8.0 in Group II, and 5.0 in Group III, with significant difference (P<0.01). There was no significant difference in the rate of tracheal tube extubation and the incidence of complication among the 3 groups (both P>0.05).
Conclusions: Surgical approach of laryngofissure combined with epiglottis valley in the treating locally-advanced piriform sinus carcinoma presents favorable outcome in terms of survival rate and laryngeal function preservation, which deserves to be promoted.
目的: 探讨喉裂开联合会厌谷入路手术对治疗局部晚期梨状窝癌的可行性及疗效。方法: 回顾性分析2013年1月至2019年12月中南大学湘雅医院耳鼻咽喉头颈外科收治的TNM分期为T3、T4a的下咽梨状窝癌初诊患者216例，采用3种不同的手术方式，其中包括采用喉裂开联合会厌谷入路术组(n=73)、咽侧入路梨状窝切除术组(n=75)和喉全切部分下咽切除术组(n=68)，所有患者术后常规予以放射治疗，术后定期随访。采用Kaplan-Meier回归模型比较不同组间的生存率，吞咽筛查量表EAT-10评估患者术后吞咽功能，并比较各组术后气管切开导管拔管率及并发症的发生率。结果: 喉裂开联合会厌谷入路组76.7%为T3期患者，咽侧入路梨状窝切除术组100%为T3期患者，喉全切部分下咽切除术组64.7%为T4a期患者，组间差异均有统计学意义(均P<0.01)；临床Ⅳ期患者在3组中的比例分别为74.0%、54.7%和89.7%，组间比较差异均有统计学意义(均P<0.01)。喉裂开联合会厌谷入路组、咽侧入路梨状窝切除术组、喉全切部分下咽切除术组3年总生存率分为69.9%、53.3%和58.8%，喉裂开联合会厌谷入路组生存率优于咽侧入路梨状窝切除术组(P<0.05)。喉裂开联合会厌谷入路组患者EAT-10量表评分中位数为12.0，咽侧入路梨状窝切除术组为8.0，喉全切部分下咽切除术组为5.0，组间比较差异有统计学意义(P<0.01)。术后气管切开导管拔管率及并发症发生率组间比较差异无统计学意义(均P>0.05)。结论: 喉裂开联合会厌谷入路手术治疗局部晚期梨状窝癌在生存率及喉功能的保留方面有较好的治疗效果，是一种值得提倡的保留喉功能的手术方式。.
Keywords: carcinoma; hypopharyngeal neoplasms; laryngeal function; survival rate; swallowing function.