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Oncological outcome after free jejunal flap reconstruction for carcinoma of the hypopharynx

机译:空肠游离皮瓣重建术后下咽癌的肿瘤学结果

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摘要

It has been a common practice among the oncologist to reduce the dosage of adjuvant radiotherapy for patients after free jejunal flap reconstruction. The current aims to study potential risk of radiation to the visceral flap and the subsequent oncological outcome. Between 1996 and 2010, consecutive patients with carcinoma of the hypopharynx requiring laryngectomy, circumferential pharyngectomy and post-operative irradiation were recruited. Ninety-six patients were recruited. TNM tumor staging at presentation was: stage II (40.6%), stage III (34.4%) and stage IV (25.0%). Median follow-up period after surgery was 68 months. After tumor ablation, reconstruction was performed using free jejunal flap (60.4%), pectoralis major myocutaneous (PM) flap (31.3%) and free anterolateral thigh (ALT) flap (8.3%). All patients underwent adjuvant radiotherapy within 6.4 weeks after surgery. The mean total dose of radiation given to those receiving cutaneous and jejunal flap reconstruction was 62.2 Gy and 54.8 Gy, respectively. There was no secondary ischaemia or necrosis of the flaps after radiotherapy. The 5-year actuarial loco-regional tumor control for the cutaneous flap and jejunal flap group was: stage II (61 vs. 69%, p = 0.9), stage III (36 vs. 46%, p = 0.2) and stage IV (32 vs. 14%, p = 0.04), respectively. Reduction of radiation dosage in free jejunal group adversely affects the oncological control in stage IV hypopharyngeal carcinoma. In such circumstances, tubed cutaneous flaps are the preferred reconstructive option, so that full-dose radiotherapy can be given.
机译:游离空肠瓣重建后,减少辅助放射治疗的剂量是肿瘤学家的普遍做法。目前的目的是研究内脏皮瓣辐射的潜在风险以及随后的肿瘤学结果。在1996年至2010年之间,连续招募了需要咽喉切除术,环咽喉切除术和术后放疗的下咽癌患者。招募了96名患者。呈报的TNM肿瘤分期为:II期(40.6%),III期(34.4%)和IV期(25.0%)。术后中位随访期为68个月。肿瘤消融后,使用空肠游离皮瓣(60.4%),胸大肌肌皮(PM)皮瓣(31.3%)和游离前大腿(ALT)皮瓣(8.3%)进行重建。所有患者均在手术后6.4周内接受辅助放疗。接受皮瓣和空肠瓣重建的人的平均总辐射剂量分别为62.2 Gy和54.8 Gy。放疗后无继发性缺血或皮瓣坏死。皮瓣和空肠瓣组的5年精算局部肿瘤控制为:II期(61%vs. 69%,p = 0.9),III期(36%vs. 46%,p = 0.2)和IV期分别为(32%vs.14%,p = 0.04)。游离空肠组的放射剂量减少不利地影响IV期下咽癌的肿瘤控制。在这种情况下,首选带皮瓣的皮瓣重建术,以便可以进行全剂量放疗。

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