Related factors of tracheostomy recurrence in laryngeal cancer

Tracheostomy recurrence after laryngeal cancer surgery is not uncommon, and most cases have a poor prognosis. The main related factors are as follows.

Unsafe surgical margins

The patient's surgical margin was positive and no further treatment was performed; the intraoperative frozen section of the surgical margin was negative, but the postoperative paraffin section of the same specimen was pathologically positive; the conventional pathological histological examination of the surgical margin was negative, but the molecular biology examination was positive. Due to the different examination methods, errors occurred, resulting in recurrence.

The surgery did not strictly follow the "tumor-free" principle

The operation should be performed in normal tissues, the surgical approach should not be through the tumor area, the tumor should not be cut or squeezed during the operation, to prevent the spread of tumor cells or contamination of the surgical field or implantation of cancer cells in the body. After the tumor is removed, the wound should be flushed with a large amount of sterile saline, and the dressing and gloves should be changed frequently before the next operation. In short, the intraoperative operation should strictly follow the tumor-free operation.

Inadequate surgical resection

At present, partial laryngectomy and function preservation and reconstruction are more popular, but it should be noted that the tumor tissue must be completely removed before the surgery, and then the laryngeal function preservation and reconstruction can be considered. Do not blindly pursue the preservation of laryngeal function, resulting in improper surgical resection and postoperative stoma recurrence.

Laser surgery does not strictly follow the indications

The local recurrence rate of early-stage glottic cancer treated with laser is 5% to 10%. Experience has shown that T1b vocal cord cancer, where the tumor is located at the anterior end of the vocal cord or invades the anterior commissure to the anterior end of the contralateral side, is prone to recurrence after laser surgery and may even expand to T2 lesions. Laser surgery for some supraglottic cancers should strictly follow the surgical indications.