Surgical Laryngeal Preservation in Early-Staged Hypopharyngeal Cancer.
- Author:
Young Chang LIM
1
;
Joo Wan KANG
;
Ji Hoon KIM
;
Sang Cheol KIM
;
Jun Wan YIM
;
Kyu Bo KIM
;
Eun Chang CHOI
Author Information
1. Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea. eunchangmd@yumc.yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
Hypopharygeal neoplasm;
Surgery;
Survival;
Postoperative complication
- MeSH:
Deglutition Disorders;
Diet;
Follow-Up Studies;
Forearm;
Free Tissue Flaps;
Gastrostomy;
Humans;
Hypopharyngeal Neoplasms*;
Hypopharynx;
Laryngectomy;
Myocardial Infarction;
Postoperative Complications;
Postoperative Period;
Pyriform Sinus;
Quality of Life;
Radiotherapy;
Skin;
Transplants
- From:Korean Journal of Otolaryngology - Head and Neck Surgery
2004;47(3):252-257
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND AND OBJECTIVES: Hypopharyngeal cancer is aggressive, grows rapidly and often tends to spread through the submucosa combined with multiple "skip lesions" or tumor satellites. Therefore, even in the early stages, most patients require wide resection, usually including total laryngectomy followed by radiotherapy. However, it is obvious that, with consideration of quality of life, the laryngeal function and cancer control are equally important. The purpose of this study is to evaluate the oncologic and functional results of laryngeal conservation surgery for early-staged hypopharyngeal cancer. SUBJECTS AND METHOD: Fourteen patients with T1 or T2 carcinoma of the various subsites of the hypopharynx, including the medial wall of pyriform sinus (four patients), lateral wall of pyriform sinus (four patients), and posterior pharyngeal wall (six patients), who were treated surgically between 1992 and 2000, were studied. All except one patient who had skin graft underwent surgical resection of the primary tumor with laryngeal preservation and immediate reconstruction with forearm free flap transfer or primary closure. Follow-up period was 6-54 months. RESULTS: One patient died in the immediate postoperative period due to myocardial infarction. However, other postoperative complications were minimal. There was no evidence of disease for at least 1 postoperative year in 7of 13 patients (53.8%) with hypopharyngeal cancer who have been performed the conservation surgery. All patients except one who died of myocardial infarction, were decannulated. All but 2 patients achieved oral intake without continuous aspiration. Of these 2 patients, one patient had severe dysphagia due to the bulkiness of the reconstructed flap and he was fed through a gastrostomy tube. The other patient died of myocardial infarction before the trial of oral diet. CONCLUSION: Our data suggest that if the precise evaluation of the extent of the tumor and a careful selection of the well adjustable patients are done preoperatively, the laryngeal conservation surgery in early hypopharyngeal cancer may be valuable in terms of oncologic and functional aspect.
