Patients With Laryngeal Cancer Partial Laryngectomy Postoperative Effects Of Influencing Factors

Objective:The laryngeal cancer is one of the most familiar malignant tumors in head-neck and the Partial Laryngectomy becomes the valid means which treats a laryngeal cancer. This study is to explore the larynx function and the long-time results of patients with Partial Laryngectomy and the prognositic factors.Methods: 130 cases of laryngeal cancer treated by Partial Laryngectomy in the department of Otorhinolaryngology in the First Clinical Hospital of Shanxi Medical University and in the head-neck department of the Shanxi Province Tumor Hospital from Jan 1996 to Sep 2002 have been retrospectively reviewed. Through checking the collected data, 10 factors(Age,Sex, Original tumor sites, T stages, Pathologic ratings, N stages, Type of larynx ablation,Surgical margins of laryngeal carcinoma,Type of neck dissection, Radiotherapy) were selected for the univariate and multivariate analysis in a Cox proportional hazard model in order to find out the prognositic factors. The Kapaln-Meier method was used to carry on an existence rate analysis; Log-Rank Test was applied to compare of survival curves; The X~2 test was applied for the evaluation of larynx function.Results: This research showed the survival rate was 74.5% at 3 years and 61.8% at 5 years. The single factor analysis manifested that original tumor sites (P=0.0080), T stages (P=0.0017), pathologic ratings(P=0.0001), N stages (P=0.0002), Surgical margins (P=0.0225)and type of neck dissection (P=0.0001) had all affected the prognosis of patients with partial laryngectomy (P<0. 05). In multivariate analysis, pathologic ratings(RR= 1.620, P=0.010) and N stages (RR=1.774, P=0.013) were the main factors affecting the prognosis of patients with partial laryngectomy, and they all were risk factors. The survival curve showed that the 5-year survival rate of patients with partial laryngectomy descended as T stages, pathologic ratings and N stages increased, meanwhile, it showed the 5-year survival rate of patients with supraglottic laryngeal cancer, surgical margins(≥5mm) or selective neck dissection is higher than glottic laryngeal cancer, surgical margins(<5mm), radical or not neck dissection. Performing supraglottic latyngectom following partial laryngectomy, the voiced function of patients is the best, on the contrary, the voiced function of those performed horizontovertical laryngectomy and extended subtotal laryngectomy is the worst; the rate of decannulation about all kinds of operative ways didn't show difference. The voiced function of patients whose larynx are reconstructed with the sternohyoideus valve are better; and using pedicled precervical skin flap in repairing defect following partial laryngectomy, the rate of decannulation is higher than others.Conclusion: The overall cumulative survival rate of patients with partial laryngectomy is 74.5% at 3 years and 61.8% at 5 years. The survival curve showed that the 5-year survival rate of patients with partial laryngectomy descended as T stages, pathologic ratings and N stages increased, meanwhile, it showed the 5-year survival rate of patients with supraglottic laryngeal cancer, surgical margins(≥5mm) or selective neck dissection is higher than glottic laryngeal cancer, surgical margins(<5mm), radical or not neck dissection. The important factors affecting patients with partial laryngectomy are tumor sites, T stages, pathologic ratings, N stages, Surgical margins and type of neck dissection, among which pathologic ratings and N stages are quite obvious. Performing supraglottic latyngectom following partial laryngectomy, the voiced function of patients is the best, and the voiced function of patients whose larynx are reconstructed with the sternohyoideus valve are better; using pedicled precervical skin flap in repairing defect following partial laryngectomy, the rate of decannulation is higher than others.