Hanyang Med Rev.  2009 Aug;29(3):231-237. 10.7599/hmr.2009.29.3.231.

Conservation Surgery for Hypopharyngeal Cancer

• Kim MS

• KMID: 1505099
• DOI: http://doi.org/10.7599/hmr.2009.29.3.231

Abstract

Hypopharyngeal carcinoma is a very aggressive cancer that is generally diagnosed at advanced stages and consequently has a poor prognosis and low survival rate. The treatment of these tumors is designed to cure the patient with the cancer and to preserve or restore physiologic function of the laryngo-pharyngeal complex as well. However, the need for extensive ablative surgery often coupled with radiation therapy renders many patients incapable of performing the basic human functions of swallowing and speech. Loss of such integral functions has a dramatically negative influence on the patients' quality of life, which has already been threatened by the aggressive nature of this disease. Therefore, it is imperative to use a reliable surgical strategy with low morbidity that will allow expedient restoration of speech and swallowing. Consequently, conservation surgery for hypopharynx carcinoma offers a wider resection with promising functional results in hypopharyngeal cancer patients. Recently several procedures were introduced for this purpose and we review the introduction and indications of those conservation methods in hypopharyngeal cancer surgery.

Keyword

Hypopharynx; Cancer; Conservation surgery

MeSH Terms

Deglutition
Humans
Hypopharyngeal Neoplasms*
Hypopharynx
Methods
Prognosis
Quality of Life
Survival Rate

Figure

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  Fig. 1 Partial pharyngectomy via the lateral pharyngotomy. (A) Area removed, including the posterolateral hypopharyngeal wall and a portion of the thyroid ala. (B) Dotted lines show cuts on the thyroid cartilage, hyoid, and vallecula. (C) After entry into the hypopharynx, the specimen is reflected laterally and final cuts are made. (D) Defect following excision of the posterolateral hypopharyngeal tumor.

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  Fig. 2-1 Case of partial pharyngectomy via lateral pharyngotomy. Right lateral wall of the hypopharynx cancer (star).

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  Fig. 2-2 Intraoperative complete excision of the tumor with safe margin.

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  Fig. 2-3 Postoperative finding shows clearly removed tumor and healing.

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  Fig. 3 Partial Laryngopharyngectomy. (A) The resection margin after a partial laryngopharyngectomy for a medial pyriform tumor is shown in the superior view. (B) This view demonstrates the bone and cartilage cuts for a partial laryngopharyngectomy. (C) The completed resection of the medial pyriform tumor is shown. The epiglottis may be divided (as described in the text) or removed completely as shown here. (D) With resection of the arytenoid, the ipsilateral true vocal cord must be sutured in the midline to the cricoid to prevent aspiration. The laryngeal mucosa is reapproximated as much as possible as shown.

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  Fig. 4 Wide Vertical Hemipharyngolaryngectomy. Top left. Vertical section of the epiglottis. A, B=two parts of epiglottis; C=thyroid cartilage; D=cricothyroid membrane; E=cricoids cartilage. Top right. Section through the inetrarytenoid space and subperichondrial dissection of the cricoids cartilage until the cricoarytenoid joint. A=right vocal cord; B=right hemiepiflottis; C=left arytenoid cartilage; D=left hemiglottis; E=cricoids cartilage; F=left vocal cord. Bottom left. Fixation of the tendon through the two drilled holes and the suture of the skin around the tendon to create a new glottis plane. A=remaining vocal cord; B=anterior fixation of tendon; C=anterior suture between the flap and the subglottic mucosa; D=cricoid cartilage; E=new glottic plane; F=radial vascular pedicle; G=cutaneous sensitive branch. Bottom right. Progressive suture between the borders of the flap and the neighboring structures, creating a new pyriform sinus. A=anterior fixation with the perichondrium of the thyroid cartilage; B, C=inferior fixation to the cricoid cartilage; D=posterior fixation to the pharyngeal mucosa.

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  Fig. 5-1 Case of wide vertical laryngopharyngectomy. Tumor involving medial wall of the right side pyriform sinus.

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  Fig. 5-2 Intraoperative finding and tumor.

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  Fig. 5-3 Reconstruction of defect by radial forearm free flap with palmaris longus tendon.

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  Fig. 5-4 Postoperative finding.

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