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Hirano T, Moriyama M, Abe N, Tateyama K, Shibata T, Takeno S, Inomata M, Suzuki M. Reconstruction using a free jejunal patch flap in salvage head and neck surgery after radiotherapy. Acta Otolaryngol 2023; 143:996-1000. [PMID: 38189417 DOI: 10.1080/00016489.2023.2298472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Chemoradiotherapy is a standard treatment for functional preservation in patients with advanced head and neck carcinoma. However, chemoradiotherapy increases the risk of postoperative complications. AIMS/OBJECTIVES We report the usefulness of reconstruction using a free jejunal patch flap in treating recurrence or residual head and neck carcinoma after radiotherapy. Furthermore, we investigated the factors for the occurrence of postoperative complications in patients who underwent salvage surgery using a free flap transfer. MATERIAL AND METHODS This study included 41 patients with head and neck carcinoma who underwent salvage surgery using a free flap transfer, including 11 patients who underwent reconstruction using a free jejunal patch flap. Prognostic analysis was performed for the development of complications. RESULTS Ten jejunal patch flaps survived without microvascular problems. One patient underwent revision reconstructive surgery because of flap failure. However, no patient had a pharyngocutaneous fistula. Oral intake could be resumed in all patients at a median 14 days postoperatively. Multivariate logistic regression analysis indicated that the use of cutaneous flaps was significantly associated with the development of complications. CONCLUSIONS AND SIGNIFICANCE Free jejunal patch flaps can be considered useful for head and neck reconstruction after radiotherapy for early intake resumption and complication prevention.
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Affiliation(s)
- Takashi Hirano
- Department of Otolaryngology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Munehito Moriyama
- Department of Otolaryngology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Nobuyuki Abe
- Department of Otolaryngology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kaori Tateyama
- Department of Otolaryngology, Faculty of Medicine, Oita University, Yufu, Japan
| | - Tomotaka Shibata
- Department of Gastroenterological Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Shinsuke Takeno
- Department of Surgery, Faculty of Medicine, Miyazaki University, Miyazaki, Japan
| | - Masafumi Inomata
- Department of Gastroenterological Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Masashi Suzuki
- Department of Otolaryngology, Faculty of Medicine, Oita University, Yufu, Japan
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Costantino A, Meliante PG, Sampieri C, Lee K, Ralli M, De Vincentiis M, De Virgilio A, Kim SH. Neoadjuvant chemotherapy and transoral robotic surgery for the posterior pharyngeal wall carcinoma. Eur Arch Otorhinolaryngol 2023; 280:4649-4655. [PMID: 37395758 DOI: 10.1007/s00405-023-08070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The squamous cell carcinoma (SCC) of the posterior pharyngeal wall (PPW) is associated with poor oncological outcomes based on current literature data. We reported the preliminary outcomes of a potential new treatment protocol based on neoadjuvant chemotherapy (NCT) and transoral robotic surgery (TORS). METHODS A retrospective single-center case series was performed including a total of 20 patients diagnosed with a SCC of the PPW between October 2010 and September 2021. All patients successfully completed TORS with neck dissection after NCT. Adjuvant treatment was performed in the presence of adverse pathologic features. Loco-regional control (LRC), overall survival (OS), and disease-specific survival (DSS) were defined as the time from surgery to tumor recurrence or death, as appropriate. Survival estimates were calculated by Kaplan-Meier analysis. Surgical data and post-operative functional outcomes were also reported. RESULTS Estimated 3-year LRC, OS, and DSS rates (95% Confidence interval) were 59.7% (39.7-89.6), 58.6% (38.7-88.8), and 69.4% (49.9-96.6). The median hospital stay was 21 days (IQR 17.0-23.5). Oral diet and decannulation were achieved after a median of 14 days (IQR 12.0-15.0). Feeding tube and tracheostomy dependence after 6 months was observed in 3 (15%) and 2 (10%) patients, respectively. CONCLUSIONS The use of NCT followed by TORS for PPW SCC treatment appears to have good oncological and functional outcomes for both early and locally advanced cancers. Further randomized trials and site-specific guidelines are needed.
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Affiliation(s)
- Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Piero Giuseppe Meliante
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, RM, Italy
| | - Claudio Sampieri
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Kyuin Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, RM, Italy
| | - Marco De Vincentiis
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
- Azienda Ospedaliera Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, RM, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Li WX, Dong YB, Lu C, Bradley PJ, Liu LF. Efficacy of Larynx Preservation Surgery and Multimodal Adjuvant Therapy for Hypopharyngeal Cancer: A Case Series Study. EAR, NOSE & THROAT JOURNAL 2022:1455613221098784. [PMID: 35537143 DOI: 10.1177/01455613221098784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Larynx preservation surgery (LPS) combined with multimodal adjuvant therapy (MAT) is re-emerging as treatment option for hypopharyngeal cancer (HPC). This study aims to explore the survival and functional outcome of this combined approach. Methods: This is a retrospective cohort study. Selected patients with primary HPC treated by LPS and MAT at two large Beijing medical centers between 2005 and 2019 were included. In addition to LPS, patients received one or more of the following treatments: preoperative induction chemotherapy, postoperative intensity-modulated radiotherapy, chemotherapy, or targeted therapy. Results: In total, 64 patients were included (62 were men, and median age was 57.5 years). The disease in most patients was in stage III (28.1%) or IV (56.3%), or in stage T2 (34.4%) or T3 (45.3%), based on the TNM scale. Across all patients, the rate of overall survival (OS) was 60.7% at 3 yr and 47.3% at 5 yr. OS was significantly higher for patients with stage I or II disease than for those with stage III or IV disease (HR 8.64, 95% CI 3.69-20.2, log-rank P = .010). Decannulation was successful in 55 patients (85.9%), and swallowing function was satisfactory (stage 0-III, on Functional Outcome Swallowing Scale) for 50 (78.1%). Median Voice Handicap Index-10 score on voice performance was 19 (range 4-40), and median Functional Assessment of Cancer Therapy-General Questionnaire score for QoL was 75 (range 16-105). Conclusions: LPS and MAT can provide satisfactory oncologic control and good functional outcomes for selected patients with HPC, especially those with stage I or II disease.
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Affiliation(s)
- Wan-Xin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
| | - Yan-Bo Dong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
| | - Cheng Lu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
| | - Patrick J Bradley
- Head and Neck Oncological Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, UK
| | - Liang-Fa Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China.,Department of Otolaryngology, Head & Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, Beijing, China
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Use of Supraclavicular Flap by End to Side Technique in Pharyngeal SCC: A Case Report and Review of Literature. Case Rep Otolaryngol 2021; 2021:6619916. [PMID: 34336336 PMCID: PMC8298143 DOI: 10.1155/2021/6619916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/19/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives In recent years, conservation laryngeal surgeries, including partial pharyngectomy, have been introduced as an alternative procedure for selected cases of hypopharyngeal squamous cell carcinoma (HSCC). Reconstruction of these defects presents a considerable challenge for the surgeon after partial pharyngectomy due to its circumferential nature. In this case report, we represent the innovative "End to side" technique to reconstruct hypopharyngeal defect using the rolled supraclavicular flap after laryngeal-preserving partial pharyngectomy. Methods and Results A 70-year-old female presented with a history of progressive dysphagia and odynophagia. The evaluations revealed a T3N0M0 SCC of pyriform sinus. The mass was successfully resected through partial pharyngectomy, and the hypopharyngeal defect reconstruction was achieved using the rolled supraclavicular flap via the "End to side" technique. The patient was discharged after decannulation on day 10. The 3-week barium swallow was performed with no evidence of anastomotic leakage, and the oral feeding was started after NG tube removal. At week 5, complete movement of the true vocal cord on the one side and good phonation and deglutition was observed. There was no evidence of recurrence after 1 year. Conclusions Laryngeal-preserving partial pharyngectomy and hypopharyngeal reconstruction with the rolled supraclavicular flap via the "End to side" technique could lead to good oncological and functional outcomes in selected cases of pyriform sinus.
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Xing MH, Ansari E, O'Malley QF, Khorsandi A, Khan MN, Urken ML. Radiation necrosis of the pharyngeal soft tissue: Unique clinical entity reconstructed with a previously unreported composite brachioradialis and flexor digitorum superficialis radial forearm flap. Head Neck 2020; 42:E23-E29. [PMID: 32783228 DOI: 10.1002/hed.26405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/13/2020] [Accepted: 07/14/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The radial forearm free flap (RFFF) is a versatile flap commonly used in head and neck reconstructive surgery. We describe the use of a composite RFFF that includes muscle for reconstruction of a hostile wound of the posterior pharyngeal wall. METHODS A 54-year-old male with a history of recurrent right palatine tonsil HPV+ squamous cell carcinoma developed severe soft tissue necrosis of the posterior pharyngeal wall secondary to reirradiation. The defect was reconstructed with a composite RFFF that included the brachioradialis (BR) muscle and the flexor digitorum superficialis (FDS) muscle. RESULTS Restoration of this complex defect was successfully accomplished with minimal donor site functional deficits and satisfactory functional outcomes including decannulation and resumption of oral intake. CONCLUSION This composite RFFF can be effectively used to reconstruct a hostile wound of the posterior pharyngeal wall. Incorporation of muscle in the reconstruction of complex wounds with soft tissue necrosis is beneficial.
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Affiliation(s)
- Monica H Xing
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
| | - Edward Ansari
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York, USA
| | - Quinn F O'Malley
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
| | - Azita Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, USA
| | - Mohemmed Nazir Khan
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York, USA
| | - Mark L Urken
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York, USA
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Bora B, Selin Ü. Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation. Braz J Otorhinolaryngol 2020; 88:174-180. [PMID: 32595079 PMCID: PMC9422742 DOI: 10.1016/j.bjorl.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/01/2020] [Accepted: 05/18/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Posterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma. Objectives To report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap. Methods The study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed. Results Nine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10–21 days). All patients achieved oral intake in a median time of 74 days (range, 15–180). Decannulation was achieved in all patients and the median time for decannulation was 90 (range, 21–300 days). The mean followup duration was 38.3 months (range, 10–71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis. Conclusion Primary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.
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Affiliation(s)
- Başaran Bora
- Istanbul University, Faculty of Medicine, Department of Otolaryngology, Istanbul, Turkey
| | - Ünsaler Selin
- Koç University, School of Medicine, Department of Otolaryngology, Istanbul, Turkey.
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7
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A systematic review of different treatment strategies for the squamous cell carcinoma of the posterior pharyngeal wall. Eur Arch Otorhinolaryngol 2020; 277:2663-2672. [PMID: 32361771 DOI: 10.1007/s00405-020-05990-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To perform a systematic review of the literature available about the posterior pharyngeal wall squamous cell carcinomas, with a special focus on oncologic outcomes. METHODS A comprehensive research was performed on PubMed/MEDLINE, Google Scholar, and Cochrane Library datasets for published studies meeting the established criteria. The last search was conducted on December 8, 2019. RESULTS Eleven studies were included in the review, for a total of 534 patients (median age 60.4; male: n = 359, 67.2%). Six of the studies evaluated the oncologic outcomes of primary surgery, while three studies focused on results achieved through primary radiotherapy. Two studies evaluated both surgery and radiotherapy outcomes for the treatment of early or advanced posterior pharyngeal wall carcinoma. CONCLUSIONS Primary surgery associated with adjuvant radiotherapy would seem to ensure better oncologic outcomes, especially for locally advanced tumors. Moreover, this systematic review showed that oro- and hypo-pharyngeal wall tumors are similar in terms of clinical and biological behavior.
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8
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Relationship between the Incidence of Postoperative Fistula or Dysphagia and Resection Style, Gastric Tube Formation, and Irradiation following Free Jejunal Flap Transfer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2663. [PMID: 32309103 PMCID: PMC7159956 DOI: 10.1097/gox.0000000000002663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022]
Abstract
Background: The purpose of this study was to examine the relationship between the incidence of dysphagia or fistula formation in an anastomotic region and factors such as extent of resection, gastric tube formation, and irradiation among patients who underwent free jejunal flap transfer. Methods: We retrospectively examined 100 cases (88 men and 12 women; average age, 65.8 years; range, 46–88 years) in whom the evaluation of postoperative oral intake was possible after undergoing total pharyngo-laryngo-esophagectomy (TPLE) and free jejunal flap transfer. Chi-square test (with Fisher transformation, if necessary) was performed to analyze the relationship among resection styles (the resection margin extended to the oropharynx or to the cervical esophagus and gastric tube elevation), radiation therapy history, and incidence of dysphagia or fistula formation. Results: One hundred patients were analyzed, and complications such as postoperative fistula and dysphagia occurred in 8 (8.0%) and 20 patients (20.0%), respectively. However, no significant correlation was found between various resection factors and fistula formation or adverse events. At the reconstruction site, other complications such as postoperative lymphorrhea (7%), postoperative hematoma (4%), trachea necrosis (4%), cervical flap necrosis (1%), and thyroid necrosis (1%) occurred. These complications were managed by a cervical open wound and additional minor operation as needed. Conclusion: Thus, free jejunal transfer for TPLE is a good reconstruction technique with few complications and postoperative adverse events, regardless of the extent of resection and preoperative radiation therapy.
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Fujisawa D, Asato H, Tanaka K, Itokazu T, Kojya S. Reconstruction of esophageal stenosis that had persisted for 40 years using a free jejunal patch graft with virtual endoscopy assistance: A case report. Arch Plast Surg 2019; 47:178-181. [PMID: 31018631 PMCID: PMC7093279 DOI: 10.5999/aps.2019.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/22/2019] [Accepted: 03/06/2019] [Indexed: 11/26/2022] Open
Abstract
In this report, we present a case in which good results were achieved by treatment using a free jejunal patch graft with virtual endoscopy (VE) assistance in a patient whose swallowing had failed to improve for 40 years after he mistakenly swallowed sulfuric acid, despite pectoralis major myocutaneous flap grafting and frequent balloon dilatation surgery. During the last 20 years, virtual computed tomography imaging has improved remarkably and continues to be used to address new challenges. For reconstructive surgeons, the greatest advantage of VE is that it is a noninvasive modality capable of visualizing areas inaccessible to a flexible endoscope. Using VE findings, we were able to visualize the 3-dimensional shape beyond the stenosis. VE can also help predict the area of the defect after contracture release.
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Affiliation(s)
- Daisuke Fujisawa
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hirotaka Asato
- Department of Plastic and Reconstructive Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Katsunori Tanaka
- Department of Otorhinolaryngology, Head and Neck Surgery, Nakagami Hospital, Okinawa, Japan
| | - Tetsuo Itokazu
- Department of Otorhinolaryngology, Head and Neck Surgery, Nakagami Hospital, Okinawa, Japan
| | - Shizuo Kojya
- Department of Otorhinolaryngology, Head and Neck Surgery, Nakagami Hospital, Okinawa, Japan
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10
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Onoda S, Kinoshita M. Salvage Surgery for Jejunal Necrosis After a Free Jejunal Transfer. Ann Surg Oncol 2019; 26:2122-2126. [DOI: 10.1245/s10434-019-07348-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 11/18/2022]
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Ishida K, Kato T, Seino Y, Uchida M. Free skin flap reconstruction after partial hypopharyngectomy with laryngeal preservation. J Plast Surg Hand Surg 2014; 48:291-6. [PMID: 24443773 DOI: 10.3109/2000656x.2013.877914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Surgical resection of hypopharyngeal cancer often affects laryngeal function. The aim of this study is to assess the reliability and efficacy of free skin flap transfer after partial hypopharyngectomy with laryngeal preservation. This study designs a retrospective analysis. The subjects were 54 patients who underwent free skin flap reconstruction immediately after partial pharyngolaryngectomy or hypopharyngectomy with laryngeal preservation. The defects were classified into four types based on the location of the hypopharyngeal defect. Functional results were evaluated by routine physical examination findings and parameters related to swallowing function and X-ray barium deglutition examination. Perioperative mortalities and morbidities were reviewed. There were no perioperative mortalities and 98% of the flaps survived. Forty-three patients (80%) were able to eat an unrestricted diet and experienced no aspiration. Restriction of the diet was significantly associated with the extent of oesophageal mucosal resection. In conclusion, free skin flap reconstruction is confirmed to be a safe and effective strategy to maintain laryngeal function and good quality-of-life.
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Mendenhall WM, Morris CG, Kirwan JM, Amdur RJ, Vaysberg M, Werning JW. Definitive radiation therapy for squamous cell carcinoma of the pharyngeal wall. Pract Radiat Oncol 2012; 2:e113-e119. [PMID: 24674173 DOI: 10.1016/j.prro.2012.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 03/16/2012] [Accepted: 03/25/2012] [Indexed: 01/15/2023]
Abstract
PURPOSE To analyze the results of definitive radiation therapy (RT) for squamous cell carcinoma of the pharyngeal wall. METHODS AND MATERIALS Between 1964 and 2009, 170 patients were treated with definitive RT; all living patients had a 1.7-year minimum follow-up. RESULTS The 5-year rates of local control and ultimate local control were the following: T1, 93% and 93%; T2, 84% and 91%; T3, 60% and 62%; and T4, 44% and 44%. Multivariate analysis revealed stage I-II tumors, female gender, and altered fractionation were associated with improved local-regional control. The 5-year cause-specific and overall survival rates were the following: I, 88% and 50%; II, 89% and 57%; III, 49% and 31%; IV, 35% and 21%; and overall, 50% and 31%, respectively. Fatal complications occurred in 9 patients (5%). CONCLUSIONS Local-regional control and survival are related to extent of disease and treatment technique. Although outcomes have improved in recent years, the morbidity of treatment is significant and a substantial proportion of patients die due to cancer.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida.
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Jessica M Kirwan
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Mikhail Vaysberg
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville, Florida
| | - John W Werning
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville, Florida
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Hirano T, Tateyama K, Kodama S, Takeno S, Suzuki M. Single-stage reconstruction of oral and hypopharyngeal double cancer with a free jejunal flap. Microsurgery 2012; 32:219-22. [DOI: 10.1002/micr.20976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 10/10/2011] [Indexed: 12/31/2022]
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The best salvage operation method after total necrosis of a free jejunal graft? Transfer of a second free jejunal graft. J Plast Reconstr Aesthet Surg 2011; 64:1030-4. [DOI: 10.1016/j.bjps.2011.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 01/29/2011] [Accepted: 02/04/2011] [Indexed: 11/20/2022]
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16
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Superficial temporal artery flap: a new option for posterior hypopharyngeal wall reconstruction. Eur Arch Otorhinolaryngol 2011; 268:1017-21. [DOI: 10.1007/s00405-011-1528-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
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Hirano S, Tateya I, Kitamura M, Kada S, Ishikawa S, Kanda T, Tanaka S, Ito J. Ten years single institutional experience of treatment for advanced hypopharyngeal cancer in Kyoto University. Acta Otolaryngol 2010:56-61. [PMID: 20879820 DOI: 10.3109/00016489.2010.487495] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Treatment of advanced hypopharyngeal cancer has become more conservative and more multidisciplinary, and the prognosis has been improved. Induction chemotherapy has the potential to extend organ preservation therapy even in cases with locally advanced primary lesion. It is also important to develop a strategy to reduce distant metastasis and to keep track of second primary cancers. OBJECTIVES To update the therapeutic outcome of advanced hypopharyngeal cancer. METHODS A total of 72 cases with stage III/IV hypopharyngeal cancer were treated at Kyoto University Hospital during 2000-2008. Surgery was performed in 56 cases; total pharyngolaryngoesophagectomy (TPLE) in 39 cases and partial pharyngectomy (PPX) preserving the larynx in 17 cases. Radiotherapy (RT) with or without concurrent chemotherapy was applied in 16 cases. Induction chemotherapy (ICT) has been applied for 14 cases since 2006 to achieve organ preservation and reduction of distant metastasis. The follow-up period varied from 12 months to 96 months (mean 32 months). Therapeutic outcomes were chart reviewed. RESULTS Five years cumulative overall and disease-specific survival (DSS) rates were 52.1% and 63.8%, respectively. DSS rates in cases treated with surgery and those with RT were 65.1% and 56.1%, respectively. N2c status showed the worst prognosis according to nodal disease classification. Local control rates for cases treated with TPLE, PPX, and RT were 97.3%, 100%, and 80.4%, respectively. The effective rate of ICT was 79%, and laryngeal preservation was achieved in 79% of the cases with ICT. Recurrence occurred in 20 cases. Approximately half of the recurrence was distant disease. In the end, 17 cases died of the primary disease, while 10 cases died of other causes, mainly second primary cancers.
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Affiliation(s)
- Shigeru Hirano
- Department of Otolaryngology Head and Neck Surgery, Kyoto University, Sakyo-ku, Kyoto, Japan.
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Reconstruction of the posterior pharyngeal wall with a deltopectoralis flap in one-step surgical intervention with larynx preservation. Plast Reconstr Surg 2010; 126:143e-144e. [PMID: 20811196 DOI: 10.1097/prs.0b013e3181e605fc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Ninety-degree transposed free jejunal patch transfer for hypopharyngeal reconstruction following partial hypopharyngectomy. Plast Reconstr Surg 2008; 122:143e-144e. [PMID: 18971689 DOI: 10.1097/prs.0b013e318186ca8a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brücher BLDM, Sarbia M, Oestreicher E, Molls M, Burian M, Biemer E, Stein HJ. Squamous cell carcinoma and Zenker diverticulum. Dis Esophagus 2007; 20:75-8. [PMID: 17227315 DOI: 10.1111/j.1442-2050.2007.00648.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Squamous cell carcinoma in a Zenker diverticulum is a very rare condition. We report a case of a patient with a Zenker carcinoma, who was primarily functionally inoperable and therefore received neoadjuvant radiochemotherapy before cardiac bypass surgery. After a complicated course with cardiogenic shock and myocardial infarction, a re-evaluation of functional risk analysis and the tumor situation revealed operability. Subsequently, partial hypopharyngectomy and partial cervical esophageal resection with lymphadenectomy was performed. Reconstruction of the gastrointestinal continuity was made by interposition of a free small bowel graft and microvascular anastomosis. The postoperative course showed a small anastomotic leakage of the hypopharyngeal-small bowel anastomosis, which was successfully treated conservatively.
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Affiliation(s)
- B L D M Brücher
- Department of Surgery, Technical University of Munich, Munich, Germany.
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Hirano S, Nagahara K, Moritani S, Takagita SI, Kitamura M, Shibayama M, Fujiwara K, Otani T. Post-operative Phonatory Status of Hypopharyngeal Cancer Patients after Laryngeal Preservation Surgery. ACTA ACUST UNITED AC 2005. [DOI: 10.2468/jbes.56.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hull MC, Morris CG, Tannehill SP, Werning JW, Amdur RJ, Hinerman RW, Villaret DB, Mendenhall WM. Definitive radiotherapy alone or combined with a planned neck dissection for squamous cell carcinoma of the pharyngeal wall. Cancer 2003; 98:2224-31. [PMID: 14601093 DOI: 10.1002/cncr.11772] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In the current study,the authors analyzed the results of definitive radiotherapy for squamous cell carcinoma of the pharyngeal wall. METHODS Between 1964 and 2000, 148 patients were treated with definitive radiotherapy. All patients had a 2-year minimum follow-up. RESULTS The following 5-year rates of local and ultimate local control were obtained: T1 disease, 93% and 93%; T2 disease, 82% and 87%; T3 disease, 59% and 61%; and T4 disease, 50% and 50%, respectively. Multivariate analysis revealed that twice-daily fractionation (P = 0.0009), American Joint Committee on Cancer Stage I-II disease (P = 0.0051), and oropharyngeal primary site (P = 0.0193) were associated with improved locoregional control. The following 5-year absolute and cause-specific survival rates were obtained: Stage I, 56% and 89%; Stage II, 52% and 88%; Stage III, 24% and 44%; Stage IV, 22% and 34%; and overall, 30% and 49%, respectively. Eight patients (5%) died of complications. CONCLUSIONS Locoregional control and survival were found to be related to site, extent of disease, and fractionation schedule. Although outcomes have improved in recent years, the morbidity of treatment was significant in the current study and a substantial proportion of patients died secondary to the malignancy.
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Affiliation(s)
- Matthew C Hull
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610, USA
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23
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Jol JKAD, Quak JJ, de Bree R, Leemans CR. Larynx preservation surgery for advanced posterior pharyngeal wall carcinoma with free flap reconstruction: a critical appraisal. Oral Oncol 2003; 39:552-8. [PMID: 12798397 DOI: 10.1016/s1368-8375(03)00037-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To report the functional and oncologic results of larynx preservation surgery with free flap reconstruction for posterior pharyngeal wall carcinoma. Retrospective medical chart review. Tertiary care referral center. We present a series of seven patients, who were treated for an advanced stage posterior pharyngeal wall carcinoma between 1995 and 1998. All patients underwent posterior pharyngectomy with larynx preservation via a suprahyoidal approach for carcinoma of the posterior pharyngeal wall, with radial forearm free flap reconstruction. Complications occurred in three patients with grade 3 comorbidity, one of whom suffered flap loss. After a mean follow-up of 48 months, three patients are alive without disease. One patient is alive with a second primary tongue carcinoma. Two patients died of disease, whereas one patient died of another cause. All patients could be decannulated and maintain their voice. Six out of seven patients were able to take oral nutrition, although four patients needed additional PEG-tube feeding. Posterior pharyngectomy with larynx preservation and radial forearm free flap reconstruction is feasible in selected patients, with acceptable functional results and survival. However, the patient must be aware of the risk of chronic aspiration and the possibility of long-term PEG feedings.
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Affiliation(s)
- Jan-Kees A D Jol
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB, The, Amsterdam, Netherlands
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25
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Julieron M, Kolb F, Schwaab G, Marandas P, Billard V, Lusinchi A, Le Ridant AM, Luboinski B. Surgical management of posterior pharyngeal wall carcinomas: functional and oncologic results. Head Neck 2001; 23:80-6. [PMID: 11303637 DOI: 10.1002/1097-0347(200102)23:2<80::aid-hed1002>3.0.co;2-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The optimal primary treatment for posterior pharyngeal wall tumors remains controversial. METHODS To assess the relevance of surgical treatment from a functional and oncologic point of view, we reviewed the cases of 77 patients surgically treated between 1984 and 1995. Among them 23 had been previously irradiated. Fifty-five patients underwent a conservative surgery (CS) sparing the larynx; 19 direct closures, 6 reconstructions of the posterior wall with a thoracic myocutaneous flap, 15 with a platysma flap, and 15 with a free forearm flap were performed. Twenty-two patients underwent radical surgery (RS). All previously untreated patients had postoperative radiotherapy. The functional assessment concerned the CS group. Oncologic results, especially local control and survival were studied for the whole group. RESULTS Of the 55 patients who underwent CS, 53 (96%) had their canula and 49 (89%) their feeding tube removed. At 1 year, in the platysma and free forearm groups, 21 of the 24 assessable patients were back to exclusive oral intake. For patients treated by primary surgery followed by radiotherapy, the rate of local failure was 11% (18% for tumors greater than 4 cm), and the 5-year survival rate was 35%. For patients who had previous radiotherapy, the rates were, respectively, 52% and 16%. CONCLUSION The satisfactory functional results, caused by the improvement of reconstructive procedures, allow conservative surgery even in the case of large tumors. Oncologic results, especially local control, suggest that primary surgery followed by radiotherapy is effective for the treatment of posterior wall cancer. The oncologic results of surgery in a previously irradiated area are poor, and CS is not recommended in these cases.
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Affiliation(s)
- M Julieron
- Department of Head and Neck Surgery, Institut Gustave-Roussy, Villejuif, France. julieronigr.fr
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Abstract
Head and neck cancer surgery continues to evolve through the years and undergo improvement and refinement. In this article, the current state of head and neck cancer surgery is summarized in a site-by-site basis. The most important developments include organ-sparing surgery and microvascular free-tissue transfer for reconstruction.
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Affiliation(s)
- S C Marks
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
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Ninković M, Harpf C, Gunkel A, Schwabegger A, Thumfart W, Anderl H. One-stage reconstruction of defects in the hypopharyngeal region with free flaps. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1999; 33:31-9. [PMID: 10207963 DOI: 10.1080/02844319950159604] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Despite the almost universal poor prognosis, the reconstruction of combined cervical skin and hypopharyngeal defects after extensive resection of tumour should maintain optimal quality of life. From 1992 to 1996 we treated 10 patients with combined skin and hypopharyngeal defects with five fasciocutaneous free flaps, three myocutaneous latissimus dorsi free flaps, one myocutaneous VRAM (vertical rectus abdominis muscle) free flap and one free radial forearm flap. None of our flaps failed. The complications that required revision (one arterial bleeding, one arterial thrombosis, two fistula formations, one superficial wound dehiscence, one haematoma) occurred mainly in those patients having secondary reconstructions. After primary extensive oncological resection of these tumours reconstruction should be done in one stage. The primary reconstruction should provide sufficient pharyngeal lining, a satisfactory covering of cervical soft-tissue, and adequate functional rehabilitation. We have reviewed our experience and conclusions about the advantages, disadvantages, and current indications for different free flaps in the reconstruction of combined hypopharyngeal, cervico-oesophageal, and cervical skin defects.
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Affiliation(s)
- M Ninković
- Department of Plastic and Reconstructive Surgery, University Innsbruck, Austria
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