Total Glossectomy With Free Flap Reconstruction: Twenty-Year Experience at a Tertiary Medical Center.

Autor: Han AY; Department of Head and Neck Surgery, Los Angeles, California., Kuan EC; Department of Head and Neck Surgery, Los Angeles, California., Mallen-St Clair J; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco Medical Center, San Francisco, California, U.S.A., Badran KW; Department of Head and Neck Surgery, Los Angeles, California., Palma Diaz MF; Department of Pathology and Laboratory Medicine, Los Angeles, California., Blackwell KE; Department of Head and Neck Surgery, Los Angeles, California.; University of California, Los Angeles Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California., St John MA; Department of Head and Neck Surgery, Los Angeles, California.; Jonsson Comprehensive Cancer Center, Los Angeles, California.; University of California, Los Angeles Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2019 May; Vol. 129 (5), pp. 1087-1092. Date of Electronic Publication: 2019 Jan 22.
DOI: 10.1002/lary.27579
Abstrakt: Objectives/hypothesis: To characterize the demographics, clinicopathologic characteristics, and treatment and reconstructive outcomes of patients who underwent total glossectomy STUDY DESIGN: Retrospective chart review at an academic tertiary-care medical center.
Methods: All patients who had undergone total glossectomy (as an individual procedure or as part of a more extensive resection) between January 1, 1995 and December 31, 2014 were included in the analysis. Patient characteristics and clinical outcomes were reviewed.
Results: Forty-eight patients underwent total glossectomy for oral tongue and base of tongue cancer. The mean age of the patients was 56 (range, 29-92 years). History of tobacco and heavy alcohol use was found in 76% and 11% of patients, respectively. The majority of patients had advanced cancer (91.7% at stage IV), and 60.4% had salvage therapy for recurrent disease. T4 disease comprised 81% of patients. Sixty percent had clinical or radiographic evidence of nodal metastasis. Reconstruction of the defect was performed with free flaps from the rectus abdominus (40%), fibula (25%), anterolateral thigh (23%), and other donor tissues. One- and 5-year survival rates were 42% and 26%, with locoregional and distant recurrence reported at 36% and 25%, respectively.
Conclusions: Total glossectomy for oncologic control is most commonly performed in patients who have stage IV cancers. Despite high reconstructive success rates, the likelihood of locoregional and distance recurrence was high. Most patients can communicate intelligibly and achieve decannulation, but swallowing outcomes remain guarded, especially considering previous irradiation and resection of the base of tongue.
Level of Evidence: 4 Laryngoscope, 129:1087-1092, 2019.
(© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE