Objective: To explore the therapeutic effect and contributing factors of pedicle nasoseptal flap in endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma. Methods: Thirty-nine patients with recurrent nasopharyngeal carcinoma admitted to the Eye, Ear, Nose and Throat Hospital of Fudan University from July 2016 to July 2019 were reviewed, with 19 males and 20 females, aging from 30 to 75 years old. All patients underwent endoscopic nasopharyngectomy, followed by reconstruction with the pedicle nasoseptal flap. The methods of preoperative assessment, mucosal flap preparation and nasopharyngeal reconstruction were summarized, and factors affecting the survival of the pedicle nasoseptal flap were discussed. The rates between groups were compared by Fisher's exact test. Results: Ipsilateral mucosal flap was used in 19 cases while contralateral mucosal flap in 20 cases. After the operation, there were 33 cases with complete epithelialization and 6 cases with flap necrosis. Univariate analysis suggested that the number of radiotherapy courses was an important factor affecting the survival of flap (OR=7.429, 95%CI: 1.120-49.270, P=0.042). However, gender, age, type of transnasal endoscopic nasopharyngectomy, osteonecrosis, side of flap and internal carotid artery resection had no influence on flap survival (all P>0.05). All patients were followed-up for 24 to 60 months. Among them, 8 patients had local recurrence and then operated again, 4 patients survived with systemic metastases and 2 patients died. Conclusion: The pedicle nasoseptal flap is a good material for reconstruction for endoscopic nasopharyngectomy, but it is less effective for patients with multiple course radiotherapy.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Nasal Surgical Procedures/methods* ; Nasopharyngeal Carcinoma/surgery* ; Nasopharyngeal Neoplasms/surgery* ; Pharyngectomy/methods* ; Surgical Flaps ; Neoplasm Recurrence, Local/surgery* ; Treatment Outcome ; Endoscopy

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: 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

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 explore the surgical treatment of hypopharyngeal and cervical esophageal cancers and the ways of reconstruction after hypopharyngo-oesphagectomy, and to evaluate their efficacy.

METHODSTwenty five patients with cancer of the laryngopharynx and cervical esophagus treated in our department between 1995 and 2007 were included in this study. Their clinical data were restrspectively analyzed. Among them, 17 cases had the tumor originated from the pyriform sinus, 3 of the posterior pharyngeal wall and 5 of the postcricoid region. Acording to the 2002 UICC criteria, all the tumors were stage T4, including 9 patients with cN0, 11 with cN1, and 5 with cN2 disease. The pharyngoesophageal defect reconstruction methods were as following: pharyngogastric anastomosis in 7 patients, free jejunal transplantion in 4, laryngotracheal flap in 8, and pectoralis major musculocutaneous flap in 6 patients. All patients were treated with modified and/or selective neck dissection. Among them, 8 cases received pre-operation radiotherapy, 17 received post-operative auxiliary radiotherapy.

RESULTSThere was no operation death case in this group. All patients were followed up for 3 to 5 years. Three patients died in the first year. According to Kaplan-Meier analysis, the 1-year survival rate was 88.0%, 3-year survival rate was 48.0%, and 5-year survival rate was 28.0%.

CONCLUSIONSThe use of primary repair of the defects of laryngopharynx and cervical esophagus expands the operative indication for cancers of the laryngopharynx and cervical esophagus, improves the survival rate and life quality of the patients. Regarding the repair method of choice, site of the tumor and size of the defect are the most important factors regarding choice of reconstruction method, while the patients' age and general condiction should also be considered to minimize the complications as more as possible.

Aged ; Carcinoma, Squamous Cell ; pathology ; radiotherapy ; secondary ; surgery ; Esophagectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Hypopharyngeal Neoplasms ; pathology ; radiotherapy ; surgery ; Hypopharynx ; surgery ; Kaplan-Meier Estimate ; Lung Neoplasms ; secondary ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Pharyngectomy ; methods ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Survival Rate

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

OBJECTIVE: To evaluate the therapeutic effect and the prognosis of the laryngeal function preserving surgery (LFPS) and total laryngectomy in hypopharyngeal carcinoma. METHOD: Ninety-three cases of laryngopharynx carcinoma were retrospectively analyzed from September 1974 to September 2006. Among which 57 cases were primary pyriform sinus cancer, 20 cases were postero-cricoid cancer and 16 cases were postero-pharyngeal wall cancer. 53 cases were treated by LFPS, and 40 cases were treated by total laryngectomy. The treatment effectiveness, complication, survival rate and repair materials were analysed. RESULT: Adopting Kaplan-Meier survival analysis, the 3-year survival rates were 69.9% and 5-year survival rates were 43.0%. The 3-year survival rates of LFPS and Non-LFPS were 73.6% and 67.5%, and the 5-year survival rates of LFPS and Non-LFPS were 49.1% and 32. 5%. There was no significant difference between the two groups (chi2 = 2.566, P > 0.05). Single element analysis indicated survival rates concerned with T-stage (chi2 = 9.764, P < 0.05), neck lymphatic transfer (chi2 = 10.472, P < 0.01) and the degree of pathological differentiation (chi2 = 25.894, P < 0.01). Cox regression analysis suggested that T-stage, the degree of pathological differentiation and whether going through the surgical operation were the independent element of the patient's prognosis. There was no significant difference between LFPS and No-LFPS in the neoplasms location, complication, neoplasms residuum and neoplasms recurrence. CONCLUSION LFPS did not affect the survival rates and LFPS was feasible. LFPS can increase the living quality of laryngopharynx carcinoma patients.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; surgery ; Female ; Humans ; Hypopharyngeal Neoplasms ; surgery ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; methods ; Larynx ; physiology ; surgery ; Male ; Middle Aged ; Pharyngectomy ; methods ; Retrospective Studies

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

OBJECTIVE: To study the treatment outcome of laryngeal function sparing of pharyngectomy in pyriform sinus carcinoma. METHOD: Fourty-two cases with pyriform sinus cancer in laryngeal function sparing surgery were collected from 1989 to 1999. The method of operation, the complication and surviving rate were analyzed. RESULT: The decannulation rate was 61.9% (26/42) . The rate of complication was 31.0% (13/42), the 3 years and 5 years' survival rates were 76.1% and 66.6% respectively. CONCLUSION Laryngeal function preserving surgery in pyriform sinus cancer could performed for stage T1, T2 and part of stage II, IV patients, and this surgery can improve the patients, life quality.
Adult ; Aged ; Carcinoma, Squamous Cell ; surgery ; Female ; Humans ; Hypopharyngeal Neoplasms ; surgery ; Laryngectomy ; methods ; Larynx ; physiology ; surgery ; Male ; Middle Aged ; Pharyngectomy ; methods ; Treatment Outcome