Estimating the risks and benefits before salvage surgery for recurrent head and neck squamous cell carcinoma
Estimating the risks and benefits before salvage surgery for recurrent head and neck squamous cell carcinoma
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DOI：
10.1016/j.ejso.2021.01.022
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发表时间：
2021-06-14
期刊：
影响因子：
3.8
通讯作者：
Dolivet, Gilles
中科院分区：
文献类型：
--
作者：
Locatello, Luca Giovanni;Mastronicola, Romina;Dolivet, Gilles
简介：在既往照射区域进行头颈部鳞状细胞癌（SCC）挽救手术的相关风险需要与预期的生存获益进行平衡。我们希望确定术前预测因素，为总体和疾病特异性生存（OS/DSS）和发展的严重（Clavien-Dindo，CD>III）放射性复发性SCC挽救手术后的并发症，以帮助外科医生、患者和护理人员在这种情况下做出决策。材料和方法：我们回顾了234名到洛林癌症研究所就诊的局部放射性复发性SCC患者的记录。主要终点为OS，次要终点为DSS、无气管造口术/胃造口术的OS和CD>III并发症的风险。结果：中位随访时间为19个月，首次挽救手术后5年OS为28.3%，5年DSS为38.9%。2-5年功能OS分别为45.6%和27.2%。rcT-rcN和WBI>4均为OS和DSS的独立显著术前预测因子。30-术后并发症发生率为44.4%（CD Ⅰ 28例，CD Ⅱ 24例，CD Ⅲ 34例，CD Ⅳ 11例，CD Ⅴ 7例）。挽救程序涉及T+N加上WUHNCI >4的存在是唯一的独立预测CD>III complication.Conclusion：当讨论与患者和护理人员挽救手术复发的头部和颈部SCC，术前合并症的仔细评估WUHNCI工具可以可靠地预测预期的风险和收益的程序。(c)2021爱思唯尔有限公司，BASO -癌症外科协会和欧洲外科肿瘤学会。All rights reserved.
Introduction: The risks associated with salvage surgery of head and neck squamous cell carcinoma (SCC) in a previously irradiated field needs to be balanced against the expected survival benefits. We want to identify preoperative predictive factors for overall and disease-specific survival (OS/DSS) and for the development of serious (Clavien-Dindo, CD>III) complications following salvage surgery for radio-recurrent SCC to help surgeons, patients, and caregivers in the decision-making process in this setting.Materials and methods: The records of 234 patients presenting to the Lorraine Cancer Institute with locoregional radiorecurrent SCC were reviewed. The primary endpoint was OS, secondary endpoints were DSS, OS without tracheostomy/gastrostomy, and the risk of CD>III complications. Multivariate analyses were carried out to explore preoperative factors associated with survival and the risk of post -operative complications.Results: With a median follow-up time of 19 months, 5-year OS since the first salvage surgery was 28.3%, 5-year DSS was 38.9%. 2-and 5-year functional OS were 45.6% and 27.2%. rcT-rcN, and WUNHCI >4 were both independent significant preoperative predictors of OS and DSS. 30-days postoperative complica-tions occurred in 44.4% of patients (28 CD I, 24 CD II, 34 CD III, 11 CD IV, 7 CD V). A salvage procedure involving T+N plus the presence of a WUHNCI >4 was the only independent predictor of CD>III complications.Conclusion: When discussing with the patients and the caregivers salvage surgery for recurrent head and neck SCC, a careful evaluation of the preoperative comorbidities by the WUHNCI tool can reliably predict the expected risks and benefits from the procedure.(c) 2021 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.