Surgical treatment and clinical course of patients with hypopharyngeal carcinoma

Abstract

In the period between 1 January 1978 and 1 January 2004, 85 patients with hypopharyngeal squamocellular carcinoma were admitted at the Department of Esophagogastric Surgery in Belgrade. Among them, only 46 patients (54.1%) had radical surgical en-block resection and functional neck dissection, and they were included into an historical cohort study. In 40 patients a pharyngolaryngoesophagectomy was performed using for reconstruction, stomach tissue in 29 and colon tissue in 11 patients. Since 1996, in six patients with localized hypopharyngeal carcinoma pharyngolaryngectomy was performed with resection of cervical esophagus and free jejunal graft interposition. The overall incidence of morbidity was 50.0% and the overall mortality rate was 13.0% (6 patients). Mean hospital stay was 35 days (range, 18-78 days). The median survival of patients was 26 months, and overall 5-year survival rate was 26.5%. At present, surgery seems to be the appropriate therapeutic choice for patients with advanced hypopharyngeal carcinoma, providing a definitive palliation of dysphagia and relatively good long-term survival. At our Institution, after pharyngolaryngoesophagectomy, reconstructive method of choice is gastric 'pull-up', and the colon is used only when stomach tissue is not available, that is, previous gastric resections, inappropriate blood supply, synchronous gastric carcinoma and so on. Recently, pharyngolaryngectomy and free jejunal transfer has become the standard technique in patients with small carcinomas (up to 3 cm) confined to the hypopharynx in the absence of synchronous esophageal and/or gastric carcinoma.

Results after radical surgical treatment for advanced carcinoma of hypopharynx

“…According to the published data total morbidity is between 30-60% [10,12,[22][23][24][25]. The morbidity rate was 46.2% in our series.…”

“…It is reported that estimation of synchronous or metachronous malignancy in such tumors is between 10-60% [10,15,[19][20][21]. The presence of synchronous malignancy in these tumors and the multicentricity should be evaluated with advanced radiologic and endoscopic procedures preoperatively.…”

“…Advances in surgical techniques, progress in the field of anesthesia and intensive care unit practices made the surgical approach to these tumors as the accepted method for treatment [10,15].…”

“…The evaluation of the stomach in terms of synchronous tumor should thoroughly be done when especially GP is planned. Endoscopy with mini probes, endoscopic ultrasonography and MRI are the most sensitive methods to be used for the evaluation of synchronous tumors and multicentricity [10].…”

“…Cases who receive radiotherapy have a 5 year survival rate of 4-20% with frequent local recurrences [3][4][5][6] whereas with radical surgical interventions especially in whom R0 resection is attained to 25-35% [2,[7][8][9]. Interest in surgical approaches have been raised within recent years due to advances in modern intensive care unit practices and progress,surgical techniques, and in the field of anesthesiology [10]. It is very unfortunate that 40% of the patients had no curative surgical treatment at the time of diagnosis [11].…”