OBJECTIVE: To investigate the locations, predisposing factors, managements and outcomes of pharyngocutaneous fistula (PCF) following total laryngectomy in patients with advanced stage hypopharyngeal or laryngeal carcinomas. METHOD: One hundred and ninety-eight patients with advanced hypopharyngeal or laryngeal carcinomas who were performed by total laryngectomy were analyzed retrospectively. The multiple predisposing factors, including age, sex, preoperative radiotherapy, previous tracheostomy, stage, differentiation, site, neck dissection and postoperative fever, were analyzed. RESULT: The incidence of PCF was 16.7%. The situations of orificium fistulae lied in 69.7% superior segment, 21.2% inferior and 9.1% middle segment respectively. The incidence of PCF was 24.7% in hypopharynx and 11.6% in larynx respectively. There were significant differences between them. The differences of postoperative continuous fever beyond 5 days were statistical significance between the group of PCF and no PCF. In them, 28 patients of PCF were healed spontaneously and 5 of them were healed by surgical operation. CONCLUSION PCF is often situated in tongue base and post-superior of trachea stoma. Tumor locations and postoperative fever are important predisposition.
Adult ; Aged ; Cutaneous Fistula ; epidemiology ; etiology ; Female ; Humans ; Hypopharyngeal Neoplasms ; pathology ; surgery ; Incidence ; Laryngeal Neoplasms ; pathology ; surgery ; Laryngectomy ; adverse effects ; Male ; Middle Aged ; Neoplasm Staging ; Pharyngeal Diseases ; epidemiology ; etiology ; Postoperative Complications ; Retrospective Studies

PURPOSE: Decision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer. MATERIALS AND METHODS: A retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer. RESULTS: The incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024). CONCLUSION: Ipsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell/epidemiology/pathology/*surgery ; Disease-Free Survival ; Female ; Humans ; Hypopharyngeal Neoplasms/epidemiology/pathology/*surgery ; Incidence ; *Laryngectomy ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasms, Second Primary/epidemiology/pathology/surgery ; *Pharyngectomy ; Predictive Value of Tests ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Thyroid Gland/*pathology/surgery ; Thyroid Neoplasms/epidemiology/*secondary ; Thyroidectomy/*methods

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Antineoplastic Agents ; therapeutic use ; Carcinoma ; epidemiology ; pathology ; radiotherapy ; Disease-Free Survival ; Female ; Humans ; Hypopharyngeal Neoplasms ; epidemiology ; pathology ; radiotherapy ; Hypopharynx ; surgery ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Radiotherapy, Adjuvant ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Sex Factors ; Smoking ; epidemiology ; Tumor Burden