Clin Exp Otorhinolaryngol.  2016 Mar;9(1):70-74. 10.21053/ceo.2016.9.1.70.

Voice Outcome in Patients Treated With Endoscopic Laryngopharyngeal Surgery for Superficial Hypopharyngeal Cancer

• Tateya I
• Morita S
• Ishikawa S
• Muto M
• Hirano S
• Kishimoto
• Hiwatashi
• Ito J

• KMID: 2166292
• DOI: http://doi.org/10.21053/ceo.2016.9.1.70

Abstract

OBJECTIVES
Endoscopic laryngopharyngeal surgery (ELPS) is a minimally invasive transoral surgery that was developed to treat superficial larygo-pharyngeal cancer, in which a mucosal lesion is resected transorally while preserving deeper structures by subepithelial injection. The purpose of this retrospective study is to evaluate voice outcome in patients who underwent ELPS for superficial hypopharyngeal cancer. As important structures in producing voice, such as intrinsic laryngeal muscles, their fascia, and recurrent laryngeal nerve, are located in the medial side of the piriform sinus and the postcricoid region of the hypopharynx, we focused on patients with cancer lesions involving these regions.
METHODS
From April 2010 to March 2011, 25 consecutive patients with superficial laryngopharyngeal cancer were treated with ELPS at Kyoto University Hospital. Among the 25 patients, 11 patients with cancer lesions on the medial side of the piriform sinus or the postcricoid area were studied. Preoperative and postoperative voice functions including maximum phonation time (MPT), mean flow rate (MFR), jitter, shimmer, soft phonation index (SPI), and noise-to-harmonic ratio (NHR), were compared retrospectively.
RESULTS
Five of 11 cancer lesions had submucosal invasion and no lesion had invaded the muscular layer pathologically. T stage was classified as Tis in 5 cases, T1 in 4 cases, and T2 in 2 cases. All lesions involved the medial side of the piriform sinus and 2 also involved the postcricoid area. Vocal fold movement was normal in all cases after the surgery. Average preoperative and postoperative values for MPT, MFR, jitter, shimmer, SPI, and NHR, were 22.7 seconds and 23.4 seconds, 165 mL/sec and 150 mL/sec, 1.53% and 1.77%, 3.82% and 5.17%, 35.5 and 36.6, and 0.13% and 0.14%, respectively. There was no statistical difference between preoperative and postoperative data for all values examined.
CONCLUSION
ELPS is useful in preserving voice function in the treatment of superficial hypopharyngeal cancer. Preserving the deeper structures including intrinsic muscles and their fascia may be important for preserving voice function as long as the lesions are superficial.

Keyword

Phonation; Laryngeal Muscles; Narrow Band Imaging

MeSH Terms

Fascia
Humans
Hypopharyngeal Neoplasms*
Hypopharynx
Laryngeal Muscles
Muscles
Narrow Band Imaging
Phonation
Pyriform Sinus
Recurrent Laryngeal Nerve
Retrospective Studies
Vocal Cords
Voice*

Figure

• 

  Fig. 1. Schematic views of the medial side of the piriform sinus and the postcricoid area. Cancer lesions involving the area (broken line) were involved in this study.

• 

  Fig. 2. Endoscopic laryngopharyngeal surgical procedure. (A) The cancer lesion identified as an unstained area by iodine staining (arrow heads) is located in the medial side of the right piriform sinus. The lesion is identified as an unstained area by iodine staining. (B) Subepithelial injection (*) is performed to lift the lesion above the surrounding mucosa and to create a safety space. Creating the safety space facilitates removal of the lesion and minimizes damage to the deep layers of the laryngopharyngeal wall, such as intrinsic laryngeal muscle, recurrent laryngeal nerve and its branch. (C) The lesion is dissected with a curved laryngeal forceps and a curved electrosurgical needle knife (Olympus Medical Systems, Tokyo, Japan). (D) The lesion was dissected and the fascia of the intrinsic laryngeal muscle and the recurrent laryngeal nerve were preserved.

• 

  Fig. 3. Representative case. (A) Superficial hypopharyngeal cancer (broken lines) spreading over one third of the postcricoid area, the entire right preform sinus, the entire posterior wall, and one third of the entrance of the esophagus. (B) About two-thirds of the hypopharyngeal mucosa and one third of the entrance of the esophagus were resected. (C) Eleven months after surgery, the right piriform sinus was totally obstructed by scarring. (D) Vocal fold movement was normal in the bilateral side and there was no glottal gap during phonation despite scar formation in the right piriform sinus.

• 

  Fig. 4. Preoperative and postoperative voice function. Average preoperative and postoperative values for maximum phonation time (MPT), mean flow rate (MFR), jitter (normal range, <1.04%), shimmer (normal range, <3.81%), soft phonation index (SPI) (normal range, <14.12), and noise-to-harmonic ratio (NHR) (normal range, <0.190), were 22.7 seconds and 23.4 seconds, 165 mL/sec and 150 mL/sec, 1.53% and 1.77%, 3.82% and 5.17%, 35.5 and 36.6, and 0.13% and 0.14%, respectively. P-values of statistical analysis (Wilcoxon signed rank test) in MPT, MFR, jitter, shimmer, SPI, and NHR were 0.900, 0.078, 0.700, 0.240, 1.000, and 0.577, respectively. There was no statistical difference between preoperative and postoperative data for all values examined.

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