Transoral laser microsurgery and radiotherapy for oropharyngeal squamous cell carcinoma: Equitable survival and enhanced function compared with contemporary standards of care.
Carotid Artery, External
/ surgery
Deglutition
Deglutition Disorders
/ epidemiology
Disease-Free Survival
Female
Fibrin Tissue Adhesive
/ therapeutic use
Gastrostomy
Humans
Laser Therapy
/ methods
Length of Stay
/ statistics & numerical data
Ligation
Male
Microsurgery
/ methods
Mouth
Neck Dissection
/ methods
Oropharyngeal Neoplasms
/ mortality
Papillomavirus Infections
Postoperative Complications
/ epidemiology
Postoperative Hemorrhage
/ prevention & control
Proportional Hazards Models
Radiotherapy, Adjuvant
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck
/ mortality
Survival Rate
Tissue Adhesives
/ therapeutic use
Treatment Outcome
Wound Closure Techniques
External carotid artery
Fibrin glue
Human papillomavirus
Oropharyngeal squamous cell cancer
Swallowing
Transoral laser microsurgery
Journal
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
29
02
2020
revised:
17
06
2020
accepted:
27
06
2020
pubmed:
8
9
2020
medline:
2
3
2021
entrez:
7
9
2020
Statut:
ppublish
Résumé
We describe the 5-year oncological and functional outcomes of transoral laser microsurgery, neck dissection (TLM + ND) and adjuvant radiotherapy (PORT) used to treat patients with oropharyngeal carcinoma. The effectiveness of external carotid artery (ECA) ligation in reducing post-operative bleeding, and fibrin glue following ND in reducing wound drainage and length of hospital stay is reported. This retrospective case review of consecutive patients undergoing TLM between 2006 and 2017 used the Kaplan-Meier Estimator and Log-Rank Test for univariate, time-to-event analyses, and Cox-Proportionate Hazard modelling for multivariate analysis. 264 consecutive patients were included. Mean follow-up was 49.4 months. 219 (82.9%) patients received PORT. Five-year overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates were 74.9%, 73.7%, and 86.2%, respectively. Five-year locoregional control was 89.4%. 65.5% of cases were Human papillomavirus associated (HPV+), for whom OS, DFS and DSS was 85.6%, 84.7% and 92.7%, respectively, and demonstrated significantly higher OS (hazard ratio (HR) 0.28, CI 0.16-0.49, p < 0.0001), DFS (HR 0.28, CI 0.17-0.47, p < 0.0001) and DSS (HR 0.2, CI 0.09-0.44, <0.001). Post-operative oropharyngeal bleeding occurred in 23 patients (8.7%), of which 5 were major/severe, in patients without ECA ligation. Fibrin glue significantly reduced neck drain output (p < 0.001), and length of hospital stay (p < 0.001). One-year gastrostomy dependence rate was 2.3%. TLM + ND + PORT results in favourable 5-year survival and locoregional control rates, and low feeding tube dependency rates. ECA ligation and fibrin glue appear to reduce major post-operative haemorrhage, wound drainage and length of hospital stay.
Identifiants
pubmed: 32893045
pii: S0748-7983(20)30570-9
doi: 10.1016/j.ejso.2020.06.045
pii:
doi:
Substances chimiques
Fibrin Tissue Adhesive
0
Tissue Adhesives
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2042-2049Informations de copyright
Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Déclaration de conflit d'intérêts
Declarations of competing interest None.