Cancer Management and Research (Jul 2020)
Effects of Anesthetic Technique on Postoperative Pulmonary Metastasis in Patients Undergoing Laryngectomy
Abstract
Xuan-Wei Huang,1,* Xu-Dong Wang,2,* Jie-Lan Lai,2 Ya-Li Lu,2 Kun Deng,3 Ren-Chun Lai2 1The First Affiliated Hospital of Sun Yat-Sen University, Department of Anesthesiology, Guangzhou 510080, People’s Republic of China; 2State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Department of Anesthesiology, Guangzhou 510060, People’s Republic of China; 3Xifeng People’s Hospital, Department of Anesthesiology, Guiyang 520122, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ren-Chun Lai Email [email protected]: Whether laryngeal cancer is directly implanted into the lungs during orotracheal intubation is still unclear. Therefore, this study aimed to find whether orotracheal intubation is an independent risk factor for postoperative pulmonary metastasis in patients undergoing laryngectomy.Patients and Methods: Medical records from January 1, 2006, to December 31, 2016, were reviewed. According to similar propensity scores, patients who received orotracheal intubation (tracheal intubation group, n = 515) were matched 1:1 with those who received tracheotomy (tracheotomy group, n = 326) in the induction of general anesthesia. The primary outcome was postoperative pulmonary metastasis. Secondary outcomes included local recurrence, lymphatic metastasis, tracheostomal recurrence and overall survival.Results: Between the two groups, there was no significant difference in postoperative pulmonary metastasis (P = 0.688), local recurrence (P = 0.215), lymphatic metastasis (P = 0.480), tracheostomal recurrence (P = 0.246) or all-cause death (P = 0.299). The primary site of cancer was an independent risk factor for pulmonary metastasis [HR 0.29, 95% CI 0.13– 0.68; P = 0.013] and local recurrence (HR 2.69, 95% CI 1.39– 5.21; P = 0.003). Type of surgery (HR 3.13, 95% CI 2.03– 4.84; P < 0.001) and N classification of TNM (HR 0.27, 95% CI 0.10– 0.75; P = 0.012) were risk factors for local recurrence. Postoperative chemotherapy was an independent risk factor for lung metastasis (HR 7.58, 95% CI 3.11– 18.47; P < 0.001) and lymphatic metastasis (HR 5.18, 95% CI 2.57– 11.91; P < 0.001), and 5-year overall survival was associated with age (P = 0.028), clinical stage (P < 0.001) and postoperative chemotherapy (P = 0.003) but not with anesthetic technique (P = 0.473).Conclusion: This retrospective study suggests that orotracheal intubation in laryngectomy is not a risk factor for postoperative pulmonary metastasis, local recurrence, lymphatic metastasis or overall survival.Keywords: laryngectomy, lung metastasis, local recurrence, tracheal intubation, tracheotomy
