- 期刊
經口機械手臂手術治療不需頸部淋巴廓清術的口咽、下咽和喉癌
Transoral Robotic Surgery for Oropharyngeal, Hypopharyngeal, and Laryngeal Cancers without the Need for Neck Dissection
摘要
背景：經口機械手臂腫瘤切除術（transoral robotic surgery, TORS）對於頭頸惡性腫瘤的病人，利用經人體自然孔洞之微創手術就能完整切除病灶，因此術後有較佳的功能保存及較低產生併發症的機率。本研究蒐集單一區域醫院執行的口咽、下咽和喉癌TORS切除手術，無執行頸部淋巴廓清術個案加以分析歸納。方法：本研究於2013年1月1日到2017年12月31日期間，將符合口咽、下咽及喉部惡性腫瘤初次診斷且單純接受TORS手術者列為研究對象，但排除進行頸部淋巴廓清術者，分析各類項目的數據。結果：共有14名男性病患進入病例分析的研究。平均年齡為55.14 ± 6.60歲。口咽癌4名（28.6％），下咽癌8名（57.1％），喉癌2名（14.3％）。臨床分期方面，分期第一期者有11名，第二期者有2名，第三期者有1名。插管天數方面，平均天數為0.79 ± 0.43日。住院天數方面，平均天數為7.36 ± 3.93日。在追蹤時間方面，平均追蹤月數為49.93個月，追蹤範圍為40-69個月。追蹤期間存活率為100％，追蹤3年整體存活率和疾病相關存活率皆為100％，3年無病存活率為85.7％。器官保留為14（100％），接受氣管切開術者為1（7.1％），需長期置入胃管灌食者為1（7.1％）。結論：本研究顯示TORS無經頸部淋巴廓清術治療對於臨床分期為I-II的口咽、下咽和喉癌病人來說，絕大多數無需做氣管切開術，並且可以做很好的器官保留的處理。3年存活率佳，與國內外所發佈的報告類似。
並列摘要
BACKGROUND: Transoral robotic surgery (TORS) is a minimally invasive surgical technique for patients with head and neck cancer and often has better functional preservation and lower complication rates after surgery. This study collected and analyzed data of all patients with head and neck cancer who were treated with TORS without neck dissection at a single regional hospital. METHODS: Study subjects included all patients who met the diagnosis of oropharyngeal, hypopharyngeal, and laryngeal malignancies and who underwent TORS from January 1, 2013, to December 31, 2017. The data of each category were analyzed. RESULTS: A total of 14 male patients were included in the case series. The average patient age was 55.14 years (standard deviation [SD] = 6.60). Five patients (28.6%) had tumors located at the oropharynx, 8 (57.1%) at the hypopharynx, and 2 (14.3%) at the larynx. In terms of clinical staging, 11 patients were stage I, 2 were stage II, and 1 was stage III. The average number of days under intubation was 0.79 (SD = 0.43). The average length of hospital stay was 7.36 (SD = 3.93) days. The average follow-up duration was 49.93 months (range, 40-69 months), with 100% survival during follow-up, 100% 3-year overall survival and 3-year disease-specific survival, and 85.7% disease-free survival. Organ preservation was achieved in all patients (100%); only 1 patient (7.1%) underwent tracheotomy and one patient (7.1%) required long-term nasogastric tube feeding. CONCLUSIONS: This study demonstrated that, for most patients with clinical stage I-II malignancies of the oropharynx, hypopharynx, and larynx, TORS without neck dissection treatment obviated the need for tracheotomy and achieved organ preservation. The 3-year survival rate was excellent and comparable with reports published both domestically and internationally.