PURPOSE: The jejunal free flap is the most standard and reliable procedure of reconstruction of the circumferential pharyngoesophageal defect because it provides pliable, elastic, secreting mucosa and posses reliable vascular anatomy. In this report, the authors introduce the modification of jejunal free flap for decreasing the complications in fatty complicated patients. METHOD: After harvesting the jejunum with mesentery and mesenteric vessels, both ends of jejunum were excised remaining the mesenteric portion. The jejunal portion of this composite flap was placed to reconstruct esophagopharyngeal defect area and the mesenteric portion was used to obliterate the dead space at paratracheal region and to cover the vital structure and the vascular anastomotic region. RESULT: A 72 year-old man with recurrent hypopharyngeal cancer who had about 15cm sized circumferential pharyngoesophageal defect after total pharyngectomy was reconstructed with jejunomesenteric composite free flap without any complications. CONCLUSION: The mesenteric flaps at both side of jejunomesenteric composite free flap provide the advantages that could obliterate dead space, that could provide cover for the vital cervical vascular structure in case of vascularity was compromised due to previous radiation therapy, and that could preserve as much vascularity at both ends of jejunal flap as possible.
Free Tissue Flaps ; Hypopharyngeal Neoplasms ; Jejunum ; Mesentery ; Mucous Membrane ; Pharyngectomy

BACKGROUND AND OBJECTIVES: Pharyngocutaneous fistula is a common serious complication following laryngectomy and pharyngectomy. However, the etiology or predisposing factors of pharyngocutaneous fistula are still unclear. The authors investigated variable predisposing factors related to pharyngocutaneous fistula by reviewing medical records. SUBJECTS AND METHOD: Two hundred ninety six of 340 cases who had been performed laryngeal and hypopharyngeal surgery were investigated. Forty nine of 296 cases (15.6%) developed pharyngocutaneous fistula. We analyzed clinical parameters such as age, gender, primary site, radiotherapy, interval between radiotherapy and surgery, neck dissection, DM (diabetes mellitus), preoperative albumin, hemoglobin etc. RESULTS: Reconstruction on surgery and peroperative albumin concentration were statistically significant factors associated with pharyngocutaneous fistula (p<0.05). CONCLUSION: Pharyngocutaneous fistula may be preventable by correcting the predisposing factors.
Causality ; Fistula* ; Laryngectomy ; Medical Records ; Neck Dissection ; Pharyngectomy ; Radiotherapy

One lung ventilation with a double-lumen endotracheal tube or Univent tube may be achieved difficultly or dangerously in some patient such as young age, anatomic anomaly, low body weight and tracheostomy patient. Bronchial blocker with a Fogarty catheter has been used successfully for such situations. Here, we reported the clinical experience in using a Fogarty embolectomy catheter as a bronchial blocker in patient with tracheostomy after pharyngectomy and laryngectomy. The patient was received left upper lobectomy with thoracotomy due to metastatic lung cancer.
Body Weight ; Catheters* ; Embolectomy ; Humans ; Laryngectomy* ; Lung Neoplasms ; One-Lung Ventilation* ; Pharyngectomy* ; Thoracotomy ; Tracheostomy*

OBJECTIVES: To evaluate the oncologic and functional results of larynx-preserving partial pharyngectomy (LPP) via lateral pharyngotomy approach as a primary treatment for small (T1 or T2) hypopharyngeal squamous cell carcinoma (HPSCC). METHODS: We performed a retrospective review of 23 patients who underwent LPP through lateral pharyngotomy approach for small HPSCC at the our department between January 1991 and June 2007. Fourteen (61%) patients had adjuvant postoperative radiotherapy. RESULTS: The 2-years and 5-years disease specific survival rate was 77% and 61%, respectively. Nine patients (39%) had tumor recurrence. The most common pattern of recurrence was isolated distant failure (n=4, 44%) followed by local (n=2, 22%) and loco-regional (n=3, 34%) recurrence. The ultimate cure rate of the primary tumor was 87% (20 of 23). Twenty-two of the 23 patients (95%) could be decannulated, tolerate an oral diet, and had acceptable postoperative phonatory function. CONCLUSION: LPP via lateral pharyngotomy approach appears to be a feasible procedure for selected small HPSCC patients in terms of both oncologic and functional outcomes.
Carcinoma, Squamous Cell ; Diet ; Humans ; Hypopharyngeal Neoplasms ; Pharyngectomy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Survival Rate

OBJECTIVES: To evaluate the oncologic and functional results of larynx-preserving partial pharyngectomy (LPP) via lateral pharyngotomy approach as a primary treatment for small (T1 or T2) hypopharyngeal squamous cell carcinoma (HPSCC). METHODS: We performed a retrospective review of 23 patients who underwent LPP through lateral pharyngotomy approach for small HPSCC at the our department between January 1991 and June 2007. Fourteen (61%) patients had adjuvant postoperative radiotherapy. RESULTS: The 2-years and 5-years disease specific survival rate was 77% and 61%, respectively. Nine patients (39%) had tumor recurrence. The most common pattern of recurrence was isolated distant failure (n=4, 44%) followed by local (n=2, 22%) and loco-regional (n=3, 34%) recurrence. The ultimate cure rate of the primary tumor was 87% (20 of 23). Twenty-two of the 23 patients (95%) could be decannulated, tolerate an oral diet, and had acceptable postoperative phonatory function. CONCLUSION: LPP via lateral pharyngotomy approach appears to be a feasible procedure for selected small HPSCC patients in terms of both oncologic and functional outcomes.
Carcinoma, Squamous Cell ; Diet ; Humans ; Hypopharyngeal Neoplasms ; Pharyngectomy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Survival Rate

OBJECTIVETo study the feasibility, surgical technique and results of laryngeal function preservation in surgical treatment for medial wall pyriform sinus cancer.

METHODSFrom 1992 to 1999, 31 patients with medial wall pyriform sinus cancer including stage I 1, II 4, III 14 and IV 12 lesions were treated. Partial resection of pyriform sinus and partial laryngectomy were performed, then, the remains of epiglottis and uni-pedicled sternohyoid myofascial flap were used to restore the defects of larynx. At last, the remaining hypopharyngeal mucosa was sutured to cover the wound of hypopharynx and for artificial rebuild-up. All patients received postoperative radiotherapy.

RESULTSThe 3- and 5-year survival rates were 62.1% and 43.6% respectively, with 77.4% patients having laryngeal functions (voice, respiration and deglutition) completely restored and 32.6% partially restored (voice and deglutition).

CONCLUSIONConservative surgery so introduced is feasible for selected medial wall pyriform sinus cancer patients with the lesion completely resected.

Adult ; Aged ; Feasibility Studies ; Female ; Humans ; Hypopharyngeal Neoplasms ; mortality ; surgery ; Laryngectomy ; methods ; Male ; Middle Aged ; Pharyngectomy ; methods

BACKGROUND AND OBJECTIVES: We evaluated treatment outcomes of patients with advanced hypopharyngeal cancer for whom surgical salvage was attempted after primary concomitant chemoradiation therapy (CRT) had failed as a treatment. The pre-salvage factors were assess-ed to predict the prognosis of salvage surgery. SUBJECTS AND METHOD: A retrospective analysis was conducted from 1997 to 2006 for 22 patients with stage III-IV hypopharyngeal cancer who had undergone salvage surgery after local and/or regional CRT failures with no distant metastasis. RESULTS: Larynx-sacrificing pharyngectomy was performed in 12 (54.5%) of all patients. Postoperative complications occurred in 9 (40.9%), and carotid artery blowout occurred in two of these patients. After salvage surgery, the 2-year and 5-year overall survival rates were 52.8% and 28.9%, respectively. The 2-year disease specific survival rate and locoregional control rate were 45.5% and 60.0%, respectively. The initial N2-3 stage (p=0.038) and the concurrent local and regional failures (p=0.035) were independent predictors for decreased survival after salvage surgery. Two-year overall survival rates for patients with 2, 1, or none of these predictive factors were 23.3%, 66.7%, and 80.0%, respectively (p=0.027). CONCLUSION: Although salvage surgery after CRT has postoperative complications and unfavorable larynx preservation, it can be considered as a viable option with acceptable oncologic outcomes for advanced hypopharyngeal cancer. The initial N2-3 stage and concurrent local and regional failures were independent predictors that can stratify patients into distinct prognostic groups for postsalvage survival.
Carotid Arteries ; Humans ; Hypopharyngeal Neoplasms ; Larynx ; Pharyngectomy ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Salvage Therapy ; Survival Rate ; Treatment Failure

PURPOSE: The purpose of this study is to compare the treatment outcomes for locally advanced resectable hypopharyngeal cancer between organ-preserving chemoradiotherapy (CRT) and surgery followed by radiotherapy (SRT). MATERIALS AND METHODS: We reviewed 91 patients with stage III/IV hypopharyngeal squamous cell carcinoma treated with radiotherapy (RT). In the CRT group (n=34), 18 patients were treated with concurrent CRT and 16 patients with induction chemotherapy plus concurrent CRT. In the SRT group (n=57), six patients were treated with total laryngopharyngectomy, 34 patients with total laryngectomy (TL) and partial pharyngectomy (PP), and 17 patients with PP, which were followed by adjuvant radiotherapy (n=41) or CRT (n=16). The median RT dose was 70 Gy for CRT and 59.4 Gy for SRT. RESULTS: Five-year local control (84.1% vs. 90.9%), and disease-free survival (DFS, 51.0% vs. 52.7%) and overall survival (OS, 58.6% vs. 56.6%) showed no significant difference between the CRT and SRT groups. The functional larynx-preservation rate was higher in the CRT group (88.2% vs. 29.8%). Treatment-related toxicity, requiring surgical intervention, occurred more frequently in the SRT group (37% vs. 12%). In the SRT group, TL resulted in a significantly higher DFS than larynx-sparing surgery (63.9% vs. 26.5%, p=0.027). Treatment outcome of the SRT group improved when only patients with TL were considered (n=40); however, 5-year OS (67.1% vs. 58.6%, p=0.830) and DFS (63.9% vs. 51.0%, p=0.490) did not improve significantly when compared to the CRT group. CONCLUSION: Organ preserving CRT provided a treatment outcome that is comparable to SRT for locally advanced hypopharyngeal cancer, while offering an opportunity for functional larynx-preservation and reduced treatment-related toxicity.
Carcinoma, Squamous Cell ; Chemoradiotherapy* ; Disease-Free Survival ; Humans ; Hypopharyngeal Neoplasms* ; Induction Chemotherapy ; Laryngectomy ; Organ Preservation ; Pharyngectomy ; Radiotherapy ; Radiotherapy, Adjuvant* ; Treatment Outcome

PURPOSE: Various attempts of reconstruction for pharyngoesophageal defects after ablative surgery have been made to restore the function of the pharyngoesophagus. A fabricated tubed radial forearm free flap or free jejunal free flap was used when the width of remnant pharyngeal wall was less than 50% of the normal width. However there are many disadvantages such as stricture, saliva leakage and fistula formation on tubed radial forearm free flap. The jejunal free flap has the problem such as short pedicle, poor tolerance of ischemic time, wet voice and delayed transit of swallowed food due to the uncoordinated contraction. The authors studied the utility of patch-type radial forearm free flap using the remnant posterior pharyngeal wall of the hypopharynx. METHODS: Retrospective reviews in Severance Hospital were made on 25 patients who underwent reconstruction surgery with patched radial forearm free flap because of the hypopharyngeal cancer between 1996 and 2005. The patients of Group I had the narrow posterior pharyngeal wall and its width was less than 3centimeters after the tumor was resected. Those of Group II had the partial pharyngectomy and the width of the remnant pharynx was larger than 3centimeters. RESULTS: Seven patients belonged to the group I and the flap of this group had 100% survival rate. One case of fistula and no swallowing discomfort due to stricture was reported. The Group II including 18 patients also had the 100% flap survival rate. Neither fistula nor stricture was seen but the lower diet grade was checked. CONCLUSION: The patch type radial forearm free flap using the remnant pharyngeal wall have the advantage of the radial forearm free flap, and furthermore this flap is the safe reconstructive method even if the width of the remnant pharyngeal wall is less than 30% of that of normal pharynx.
Constriction, Pathologic ; Deglutition ; Diet ; Fistula ; Forearm* ; Free Tissue Flaps* ; Humans ; Hypopharyngeal Neoplasms* ; Hypopharynx ; Pharyngectomy ; Pharynx ; Retrospective Studies ; Saliva ; Survival Rate ; Voice

Partial laryngectomy and pharyngectomy have been suggested for localized hypopharyngeal cancer to preserve the function of larynx. In case of limited partial laryngectomy, local soft tissue flaps are sufficient to provide adequate bulk for glottic closure. However, in case of extensive partial laryngectomy procedure in which more cartilaginous framework is resected, we feel an increased necessity of considering 'hard tissue' as well as soft tissue restoration to prevent airway collapse and glottic incompetency. We have tried radial forearm free flap including palmaris longus tendon for reconstruction of glottis and hypopharynx following a wide vertical hemilaryngopharyngectomy. We had 2 patients with hypopharyngeal cancers localized in pyriform sinus. The tendon was secured so as to drill holes in the cricoid and thyroid cartilage at the glottic level to help maintain the position of soft tissue lining and sewe as buttress for mobile vocal cord. A good restored phonation and respiration were obtained in two cases of hypopharyngeal cancer patients. But one patient suffered from frequent aspiration due to esophageal inlet stricture after radiation therapy.
Bays ; Constriction, Pathologic ; Forearm* ; Free Tissue Flaps* ; Glottis* ; Humans ; Hypopharyngeal Neoplasms ; Hypopharynx ; Laryngectomy ; Larynx ; Pharyngectomy ; Phonation ; Pyriform Sinus ; Respiration ; Tendons ; Thyroid Cartilage ; Vocal Cords