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: 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

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

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

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

OBJECTIVETo evaluate the efficacy of surgical treatment and combined therapy of advanced pyriform sinus cancer.

METHODSTotally 153 patients with locally advanced pyriform sinus cancer who received surgical treatment in our department from January 1974 to December 1999 were divided into three groups: preoperative radiotherapy with 45.5 Gy followed by surgery (R + S group, n = 125), including 32 laryngeal function sparing surgery; surgery alone (Sa group, n = 13); and surgery followed by postoperative radiotherapy with 56.3 Gy (S + R group, n = 15). Twenty-one patients received piriformectomy, 10 piriformectomy plus partial laryngectomy, and 1 total hypopharyngectomy and pharyngoesophagectomy with laryngeal spared and colon reconstruction. Among 121 patients who did not receive laryngeal function sparing surgery, 13 received near total laryngectomy, 55 total laryngectomy, and 53 total laryngectomy plus total hypopharyngectomy and pharyngoesophagectomy with reconstruction. Eight-six patients received radical neck dissection, 14 modified neck dissection, and 6 lateral neck dissection. Survival rate and laryngeal function sparing rate were analyzed using Kaplan-Meier and COX model respectively.

RESULTSThe overall 5-year survival rates were 46.51% in R + S group, 18.33% in Sa group, and 44.44% in S + R group. Laryngeal sparing rate were 13.61% (R + S group), 0 (Sa group), and 0 (S + R group), respectively. R + S group, S + R group and combined therapy group (R + S group plus S + R group) showed superiority over Sa group in teams of 5-year survival rate (P = 0.0364, P = 0.0462, P = 0.000). R + S group showed superiority over S + R group and Sa group in teams of laryngeal sparing rate. Therapy mode was the most important factor that contributed to 5-year survival rate and laryngeal sparing. No significant differences were found in complication rate among the groups.

CONCLUSIONPreoperative radiotherapy conduces to preserve laryngeal function of patients with locally advanced pyriform sinus carcinoma.

Adult ; Aged ; Carcinoma, Squamous Cell ; mortality ; radiotherapy ; surgery ; Female ; Humans ; Hypopharyngeal Neoplasms ; mortality ; radiotherapy ; surgery ; Laryngectomy ; methods ; Larynx ; physiopathology ; Lymph Node Excision ; Male ; Middle Aged ; Pharyngectomy ; methods ; Proportional Hazards Models ; Radiotherapy, Adjuvant ; Survival Rate

OBJECTIVETo discuss the use of free jejunal flap in reconstruction for circumferential defect after tumor resection of hypopharyngeal and cervical esophageal cancer.

METHODSRetrospective review of 51 patients who underwent circumferential pharyngoesophageal reconstruction with free jejunal flap after tumor ablation.

RESULTSIn 51 patients, 5 had flap failure and the flap success rate was 90% (46/51). Forty-five patients had oral intake after operation excluding one who had anastomosis stenosis and 5 who had flap failure. The 1-year and 3-year survival rate was 62% and 48% respectively. Positive surgical marginal status and external invasion including thyroid gland, carotid artery, skin and pre-vertebral area were indicators for bad prognosis. Except 5 patients who had flap failure, one of which died from mediastinal infection, no other severe complications occurred.

CONCLUSIONSPatients reconstructed with free jejunal flap after resection of hypopharyngeal and cervical esophageal cancer had low mortality and few complications. Those without positive surgical margin and external invasion including thyroid gland, carotid artery, skin and pre-vertebral area had higher survival rate. Most of them had good quality of life. The choice of free jejunal flap for reconstruction of hypopharyngoesophageal defect was appropriate in selected patients who had guarantee of negative surgical margin and no external invasion.

Adult ; Aged ; Esophageal Neoplasms ; mortality ; surgery ; Esophagectomy ; Female ; Humans ; Hypopharyngeal Neoplasms ; mortality ; surgery ; Jejunum ; surgery ; Male ; Middle Aged ; Pharyngectomy ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Surgical Flaps ; Survival Rate

OBJECTIVETo explore the feasibility and the related surgical techniques of laryngeal function preservation in surgical treatment of pyriform sinus cancer.

METHODSTwo hundred and thirty cases (stage I, 6; stage II, 10; stage III, 91; stage IV, 123) with pyriform sinus cancer were treated surgically from 1978 to 1996 in the Department of Otorhinolaryngology of Qilu Hospital of Shandong University. The methods of removing tumor and repairing surgical defects were depended on the extension of lesions. The laryngeal and pharyngeal functions were rebuilt by normal tissue preserved with lesions entirely removed. One hundred and fifty-eight cases were surgically treated with laryngeal functions preserved and 72 cases total laryngectomy. The most of the cases received postoperative radiotherapy.

RESULTSThe overall 3 and 5 year survival rates were 67.4% (155/230) and 48.3% (111/230) respectively. For stage I, the survival rate was 5/6; stage 11, 70.0% (7/10); stage III, 57.1% (52/91) and stage IV, 38.2% (47/123); the 3 and 5 year survival rates in functionally preserved group were 67.7% (107/158) and 50.0% (79/158), while in none functional group were 66.7% (48/72) and 43.1% (31/72), respectively. 75.3% (119/158) patients have laryngeal functions (voice,respiration and deglutition) completely restored and 24.7% (39/ 158) partially restored(voice and deglutition).

CONCLUSIONSThe preservative surgery is feasible for the selected pyriform sinus cancer cases. Choosing and following optimum surgical methods is a prerequisite for improving the quality of life of the cases.

Adult ; Aged ; Carcinoma, Squamous Cell ; surgery ; Female ; Humans ; Hypopharyngeal Neoplasms ; surgery ; Larynx ; surgery ; Male ; Middle Aged ; Pharyngectomy ; methods ; Survival Rate ; Treatment Outcome

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