[Pharyngolaryngectomy for advanced and recurrent cancer: prognostic factors and complications].
BACKGROUND
The aim of this study was to evaluate the results of the initial surgical treatment and salvage treatment for advanced laryngopharyngeal cancer.


METHODS
From 1984 to 1997, primary surgical treatment was undertaken in 60 patients. 75 patients underwent surgical salvage following radiotherapy.


RESULTS
55/135 patients (40.7%) experienced local regional relapse. The overall survival at 5 years was 43.9% in the first group of patients treated initially with surgery. In the group of patients treated with salvage surgery, the overall survival at 5 years was 40.2%. A multivariate analysis showed that involved lymph nodes (p = 0.0004), a nutritional score inferior to 5 (p = 0.03), positive resection margins (hazard ratio 2.05; 95% c.i. 1.03 to 4.04 ; p = 0.03), a local-regional relapse (p = 0.04) and appearance of metastasis (p = 0.03) were independent risk factors for overall survival. Survival is dependent from each factor, and each factor is independent from each other Stenosis was rare: 5.1% in the present series. A pharyngocutaneous fistula developed in 49.6% of patients. After a multivariate analysis, the site of the tumor (odds 2.26; 95% c.i. 1.05 to 4.85; p = 0.03) had an influence for apparition of a fistula.


CONCLUSIONS
Initial surgical surgery and salvage surgery of respectively 43.9% and 40.2% overall survival compares favorably with the literature. Despite progress made with reconstruction, morbidity is still elevated in a selected group defined after analysis of pronostic factors.
Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Clinique de Chirurgie Cervico-Faciale, I rue Héger Bordet, B-1000 Bruxelles, Belgique. suzanne.devaux@bordet.de
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Dequanter
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Lothaire
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Comblain
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Philippart
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De Wan
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Deraemacker
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Andry
D000368:Aged; D003251:Constriction, Pathologic; D005260:Female; D005402:Fistula / Q000209:etiology; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D010611:Pharyngectomy / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome