Reconstruction of the hypopharynx using hemilarynx for localized pyriform sinus cancer

Hemilaryngeal flap for hypopharyngeal reconstruction in pyriform sinus carcinoma

CONCLUSION

The hemilaryngeal flap is a technique for hypopharyngeal reconstruction with the use of adjacent uninvolved tissue. The technique's advantages are that it is technically simpler than other surgical techniques for hypopharyngeal reconstruction, and involves no donor site morbidity. Its disadvantages are that it only can be employed in tumors which are confined to one side of the hemilarynx, and also there is always potential for skip lesions and incomplete resection.

OBJECTIVE

To determine the indications, oncologic considerations, complication rate and survival of the surgical technique.

MATERIALS AND METHODS

A meta-analysis of the available literature using the Medline database.

RESULTS

There are 86 reported cases. The surgical technique was used only when one side of the hypopharynx was spared. Pharyngocutaneous fistulae developed in 16 patients (19%) and 2 patients developed pharyngeal stenosis. The technique was employed with advanced squamous cell carcinoma of the hypopharynx and the survival rates are similar to those reported when other reconstruction techniques are used.

Contralateral hemilaryngotracheal flap reconstruction of the hypopharynx in pyriform carcinoma resection

OBJECTIVES

To simplify the approach and reconstruction for advanced hypopharyngeal cancer, a modified technique-laryngotracheal fissure approach and laryngotracheal flap reconstruction--is presented.

STUDY DESIGN

Prospective.

METHODS

From August 1991 to December 1995, 44 consecutive patients with advanced hypopharyngeal cancer, mostly involving pyriform sinus, were operated on with this technique. The functional and oncologic results and complications were evaluated.

RESULTS

Reconstruction was completed by using the laryngotracheal flap in 75% of patients, while the other 25% required additional patch-on pectoralis major myocutaneous flaps. Pharyngoesophageal stenosis occurred in one patient after radiotherapy and pharyngocutaneous fistula was noted in two. No local recurrence was noted. Seven cervical metastases developed in the follow-up period and six over the contralateral neck not treated surgically. The 5-year Kaplan-Meier disease-free survival was 46.8%.

CONCLUSIONS

The authors' experience indicates that this is a simplified, radical treatment for most advanced hypopharyngeal cancer, with high applicability, good oncologic results, and low complication.