A prospective clinical trial of the second-look procedure for transoral surgery in patients with T1 and T2 laryngeal, oropharyngeal, and hypopharyngeal cancer.
A prospective clinical trial of the second-look procedure for transoral surgery in patients with T1 and T2 laryngeal, oropharyngeal, and hypopharyngeal cancer.
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T1 和 T2 喉癌、口咽癌和下咽癌患者经口手术二期手术的前瞻性临床试验。
DOI：
10.1002/cam4.2588
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Oridate Nobuhiko.
中科院分区：
文献类型：
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作者：
Nishimura Goshi;Sano Daisuke;Arai Yasuhiro;Hatano Takashi;Takahashi Hideaki;Tanabe Teruhiko;Wada Takashi;Morishita Daiki;Oridate Nobuhiko.
经口腔外科手术(TOS)已广泛应用于早期T期头颈部癌(HNC)。手术切除是在有限的手术范围内以最小的安全裕度保留功能，因此，很难对完全切除有强烈的信心。本研究旨在评估早期T期喉癌、口咽癌和下咽癌患者TOS手术的完备性、单纯TOS进行初步控制的可能性以及预测因素。根据手术标本的病理评价将患者分为两组：对照组(观察组)，认为肿瘤切除已完成；干预组(复查)，怀疑肿瘤切除不全。然后分析TOS完全切除的可能性和/或局限性的预测因素。结果对照组和干预组分别有26和25名患者。一次切除成功率为66%，预测因素为CT增强扫描获得的肿瘤深度(优势比，7.870，P=10.0243)。单纯TOS明确治疗的成功率为83%，预测因素为病理组织学低分化(优势比6.800，P=0.0248)。结论TOS具有明确切除和保留功能的潜能，且侵袭性小。明确TOS的危险因素有利于早期T期HNC患者准确的治疗选择。
BackgroundTransoral surgery (TOS) has been widely applied for early T‐stage head and neck cancer (HNC). The resection is performed with a minimum safety margin for function preservation under a limited surgical field; therefore, it is difficult to have a strong conviction about the complete resection. This study aims to evaluate the completeness of the initial TOS procedure; possibility of primary control by TOS alone; and predictive factors in patients with early T‐stage laryngeal, oropharyngeal, and hypopharyngeal cancer.MethodsPatients were treated by TOS at the primary site with or without neck dissection. The patients were divided into two groups based on the pathological evaluation of their surgical specimens: the control (observation) group, in that the resection was considered complete and the intervention (second‐look procedure) group, in that incomplete tumor resection was suspected. The predictive factors for the possibility and/or limitations of complete resection by TOS were then analyzed.ResultsThe study enrolled 26 and 25 patients in the control and intervention group, respectively. The success rate for single resection was 66% and the predictive factor was tumor depth obtained by enhanced computed tomography (CT) examination (odds ratio, 7.870,P= .0243). The success rate for definitive therapy by TOS alone was 83% and the predictive factor was poor differentiation observed on pathological examination (odds ratio, 6.800,P= .0248).ConclusionsTOS has the potential for both definitive resection and function preservation with minimal invasiveness. Identification of the risk factors for TOS is advantageous for accurate treatment selection in patients with early T‐stage HNC.