| ObjectiveThis retrospective study was designed to analyze the risk factors of prognosis in patients with laryngeal cancer,and summarize the experience of surgical resection and laryngeal function reconstruction.MethodsThe clinical data of 559 patients with laryngeal cancer who underwent surgical treatment in the department of Otolaryngology,Qilu Hospital of Shandong University from Jan.1st,2011 to Dec.31st,2016 were retrospectively analyzed.According to the location,invasion range and lymph node metastasis,appropriate methods of tumor resection,defect repair and neck dissection were selected.According to postoperative pathology,suitable adjuvant treatments such as radiotherapy and chemotherapy were selected after the operation.The risk factors of postoperative survival rate,recurrence,complications and speech rehabilitation were analyzed.ResultAmong the 559 patients,98(17.5%)were supraglottic type,450(80.5%)were glottic type,and 11(2.0%)were supraglottic type.There were 64 cases of Tis,230 of T1,130 of T2,106 of T3,29 of T4;480 of N0,37 of N1.42 of N2,and 0 of N3.As for clinical stage of tumor,64 were stage 0,223 were stage ?,105 were stage ?,104 were stage ? and 63 were stage ?.Among the 559 patients,107(19.1%)cases underwent carbon dioxide laser resection,302(54.0%)were treated by laryngeal vertical partial resection;62(11.1%)underwent supraglottic laryngectomy;because of large scale and the aim of laryngeal reservation,other surgeries including 3/4 laryngectomy,SCPL-CHP/CHEP subtotal laryngectomy were performed in 26(4.7%)patients.62(11.1%)cases underwent total laryngectomy.The total laryngeal reservation rate was 88.9%.From the first day of surgery to the third day after surgery,435 patients(77.8%)had fever(body temperature higher than 37.5?),and 155 patients(27.7%)showed increased body temperature two days after resuming oral feeding.140 patients were in nasogastric tube after the operation.The median time of bearing nasogastric tube was 15 days(14,17),and the removal rate of gastric tube was 100%.Postoperative weight loss was 2.97±2.87kg,2.65±2.74kg in the group without nasogastric tube and 3.95±3.04kg in the group with nasogastric tube(F=4.067,p=0.044).The total follow-up time of the retrospective study was 113.4 months,and the 1,3 and 5-year overall survival rates of the patients were 91.9%,84.2%and 78.4%respectively,with a median survival time of 55.7 months.The effects of primary tumor size,T stage,N stage,clinical stage and NLR on prognosis were statistically different(all p=0.000).Among all 559 cases,73(13.1%)showed postoperative recurrence within 5 years after the operation.Primary tumor size,T stage,clinical stage and pathological grade were independent risk factors for postoperative recurrence of laryngeal cancer.Postoperative complications included incision-related complications in 37 cases(6.7%),lower respiratory tract infection in 15 cases(2.7%).In 390 patients undergoing temporary tracheotomy,48(8.6%)cases showed respiratory difficulties after removing tracheotomy tube with 18 patients continued to wear tracheotomy tubes.The extubation rate was 95.4%.ConclusionT and N staging,clinical staging,pathological malignancy,size of primary tumor and NLR are risk factors for prognosis of laryngeal cancer.It is of great significance in improving the survival and quality of life by making individualized surgical plans,selecting appropriate surgical approaches,tumor resection and repair methods. |
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