Partial pharyngolaryngectomy with infrahyoid flap: Our experience

Influencing Factors of Survival in Hypopharyngeal Squamous Cell Cancer

Objectives: This study examined the effects of various factors on survival in hypopharyngeal cancer, involving a total of 100 patients. Methods: Comorbidities, treatment modalities, survival times, and potential factors affecting survival were retrospectively analysed. The expression of p16 was also examined. A statistical analysis was conducted using IBM SPSS V25 software. Results: The mean overall survival time was determined to be 30.8 months. Smoking was observed in 95%, and regular alcohol consumption was reported in 75% of the cases. The expression of p16 did not significantly affect survival (p = 0.74) or the maximum tumour size (p = 0.21). The Kaplan-Meier method demonstrated significantly longer survival times (p = 0.047 *) in the group that underwent partial pharyngolaryngectomy with or without adjuvant therapy (median: 75.25 months, 95% CI: 31.57-118.93), compared to the other four treatment groups (i.e., total laryngectomy with pharyngectomy with or without adjuvant therapy, chemoradiation, chemotherapy, and radiotherapy). Conclusions: The study found that factors such as sex, comorbidities (e.g., type 2 diabetes and chronic obstructive pulmonary disease), TNM and stage, weight loss, smoking, and alcohol consumption did not have a significant effect on survival. In conclusion, the longest survival was observed after partial pharyngolaryngectomy with or without adjuvant therapy. Risk factors and comorbidities did not show a significant effect on survival. p16 expression was not a factor that affected either survival or tumour size.

Infrahyoid myocutaneous flap in head and neck reconstruction: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to analyse the literature on the infrahyoid myocutaneous flap (IHMCF) and evaluate its clinical outcomes. The MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus databases were searched (inception to December 31, 2021). Meta-analyses were then conducted to estimate the overall rates of partial flap loss, total flap loss, salivary fistula, and surgical revision. The 21 studies that met the inclusion criteria included 768 patients undergoing head and neck reconstruction with 773 IHMCF. The oral cavity (77.7%) and oropharynx (13.0%) were the most reconstructed sites. The meta-analyses estimated a pooled partial flap loss rate of 10.4% (99% confidence interval (CI) 5.4-16.7%), total loss rate of 1.8% (99% CI 0.8-3.2%), salivary fistula rate of 3.0% (99% CI 1.3-5.3%), and surgical revision rate of 1.9% (99% CI 0.7-3.7%). Fast flap harvesting and low donor site morbidity were other flap features. Previous thyroid surgery or neck dissection and advanced lymph nodal stage were considered contraindications to IHMCF reconstruction by most authors, while prior neck radiotherapy was reported as a relative contraindication. This pedicled cervical flap is a versatile and reliable reconstructive option for medium-sized head and neck defects. Careful preoperative assessment of the neck condition allows for its safe use.

Efficacy of Larynx Preservation Surgery and Multimodal Adjuvant Therapy for Hypopharyngeal Cancer: A Case Series Study

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.

[Surgical de-escalation for head and neck cancer surgery]

Head and neck cancer surgery often has functional and aesthetic consequences. De-escalation surgery is a major concern for surgeons with a constant desire to develop surgical techniques with less invasive approaches and to preserve anatomical structures as much as possible. This was made possible by the appearance of minimally transoral and endonasal surgery as well as by the limitation of the surgical procedure by neoadjuvant treatments or by the limitation of surgical excision without compromising the oncological outcome and patient survival. This evolution continues with the arrival of new technologies such as virtual reality or artificial intelligence.