Issue N# 2 - 2004
Pharyngolaryngectomy for advanced and recurrent cancer: Prognostic factors and complications
Authors : D. Dequanter, Ph. Lothaire, M. Comblain, J. Philippart, J. De Wan, R. Deraemacker, G. Andry (Bruxelles)
Ref. : Rev Laryngol Otol Rhinol. 2004;125,2:93-101.
Article published in french
Downloadable PDF document french
Introduction: The aim of this study was to evaluate the results of the initial surgical treatment and salvage treatment for advanced laryngopharyngeal cancer. Methods: From 1984 to 1997, primary surgical treatment was undertaken in 60 patients. 75 patients underwent surgical salvage following radiotherapy. Results: 55/135 patients (40.7%) experienced local regional relapse. The overall survival at 5 years was 43.9% in the first group of patients treated initially with surgery. In the group of patients treated with salvage surgery, the overall survival at 5 years was 40.2%. A multivariate analysis showed that involved lymph nodes (p = 0.0004), a nutritional score inferior to 5 (p = 0.03), positive resection margins (hazard ratio 2.05 ; 95 % c.i. 1.03 to 4,04 ; p = 0.03), a local-regional relapse (p = 0.04) and appearance of metastasis (p = 0.03) were dependent risk factors for overall survival. Stenosis was rare: 5.1% in the present series. A pharyngocutaneous fistula developed in 49,6% of patients. After a multivariate analysis, the site of the tumor (odds 2.26 ; 95% c.i. 1.05 to 4.85 ; p = 0.03) had an influence for apparition of a fistula. Conclusion: Initial surgical surgery and salvage surgery of respectively 43.9% and 40.2% overall survival compares favorably with the literature. Despite progress made with reconstruction, morbidity is still elevated in a selected group defined after analysis of pronostic factors.
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