Korean Journal of Head & Neck Oncology (대한두경부종양학회지)

The Korean Society for Head and Neck Oncology (대한두경부종양학회)
권호 표지

Stomal Recurrence after Total Laryngectomy - A Critical Analysis of Etiology and Therapeutic Problems­

후두전적출술 후 기공주변의 재발

  • Choi Jong-Duck (Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Korea University) ;
  • Jung Kwang-Yoon (Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Korea University) ;
  • Oh Jae-Hoon (Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Korea University) ;
  • Kim Young-Hwan (Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Korea University) ;
  • Kim Byong-Hoon (Department of Otolaryngology, Capital Armed Forces General Hospital)
  • 최종욱 (고려대학교 의과대학 이비인후-두경부외과학교실) ;
  • 정광윤 (고려대학교 의과대학 이비인후-두경부외과학교실) ;
  • 오재훈 (고려대학교 의과대학 이비인후-두경부외과학교실) ;
  • 김용환 (고려대학교 의과대학 이비인후-두경부외과학교실) ;
  • 김병훈 (국군 수도병원)
  • Published : 1994.11.01
Download PDF
⟨ Previous Next ⟩

Abstract

Stomal recurrence after total laryngectomy presents serious therapeutic problems despite aggressive treatment methods. The purpose of this study is to evaluate the critical analysis of etiology and treatment results and to clarify the treatment plans and prevention of stomal recurrence. Among 159 cases who had undergone total laryngectomy for cancers of larynx(135 cases) and hypopharynx(24 cases) during recent 10 years, stomal recurrence occured in 12 cases(1 case with type I, 2 cases with type II, 2 cases with type III, 3 cases of type IV and unclassified 4 cases according to Sisson's classification) and the retrospective analysis of results were as follows: 1) Average duration of stomal recurrence was $8.2{\pm}4.35$ months after cessation of primary treatment. 2) The overall incidence of stomal recurrence was 7.6%. 3) The suggested etiology in the pathogenesis of stomal recurrence could be inadequate surgical margin, delayed laryngectomy after initial tracheostomy and improper management of metastatic nodes. 4) Mean survival time was $7.3{\pm}5.61$ months and one case with type I underwent surgical salvage is still alive out of 7 cases with chemotherapy and radiotherapy and 5 cases with surgical salvage and adjacent therapy. In summary, aggressive surgical resection should be recommended in cases with high risks of stomal recurrence.

최근 10년간 후두전적출술을 시행하였던 159례 중 기공주변 재발이 발생하였던 12례에 대하여 후향적으로 분석함으로써 다음과 같은 결과를 얻었다. 1) 기공주변의 재발은 1차 치료종결후 평균 8.23개월에 발견되었으며, 발생빈도는 7.55%이었다. 2) 추정 원인은 광범위한 원발병소로 인한 부적절한 절재연, 기관절개술후 근치수술의 지연, 불완전한 림프전이절의 처리 순이었다. 3) 7례는 항암화학요법(국소 또는 전신적)과 고식적 방사선요법을 시행하였으며, 5례는 구제수술을 시행한 후 고식적 방사선요법 및 항암화학요법을 시행하였으나 구제수술을 받은 제 1형 1례를 제외하고는 모두 사망하였으며, 평균 생존기간은 $7.32{\pm}5.61$개월 이었다. 이상의 성적에서 기공주변의 재발 가능성이 높은 고위험군에 대하여는 광범위한 절제 후 적극적인 추적관찰과 더불어 과감한 구제수술로 생존기간을 연장할 수 있을 것으로 생각되었다.

Keywords