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Objectives: Transoral approaches for laryngeal/pharyngeal malignancies have been widely accepted as minimally invasive treatment options; however, hypopharyngeal lesions treated by transoral surgery have rarely been reported due to the difficulties in visualizing the hypopharynx. Since 2010, we have treated superficial hypopharyngeal lesions with endoscopic laryngopharyngeal surgery (ELPS), and herein report the outcomes of this transoral procedure., Materials and Methods: One hundred and eighteen patients with superficial hypopharyngeal lesions were treated by ELPS from February 2010 to February 2017, and the clinical courses of the patients were reviewed., Results: Four females and 114 males (average: 65.6 y-o) were included in this study. Some patients had multiple lesions and a total of 154 superficial hypopharyngeal lesions (dysplasia: 29, Tis: 52, T1: 44, T2: 20, T3: 9) were treated with ELPS. Ten patients had only dysplasia and no carcinoma. Five patients presented with nodal metastases and 11 patients had simultaneous oropharyngeal lesions. In all cases, the hypopharynx was well visualized with sufficient working space, and no cases required a change in surgical approach. All post-operative complications were safely managed. In regard to the oncological outcomes, of the 108 patients with malignant lesions, the 3-year and 5-year overall survival (OS) rate was 93.6% and 85.5%, respectively., Conclusions: During ELPS, the hypopharynx was well visualized providing sufficient working space for the resection. The procedure was safe and feasible for superficial hypopharyngeal lesions and exhibited very good oncological outcomes. ELPS is thought to be a very effective surgical alternative for superficial hypopharyngeal lesions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Upper cervical oesophageal and hypo-pharyngeal malignancies pose significant challenges in surgical management. In advanced tumours total laryngopharyngeal esophagectomy (TLPO) and gastric pull up provides excellent result., Methods: It is a descriptive case series and was conducted from Jan 2010 to Jan 2017. Thirty-five patients underwent TLPO. The inclusion criteria were; tumours of hypo-pharynx which allow tumour free resection margins and cervical oesophageal tumours not involving mediastinal trachea. There were no clinically palpable cervical lymph nodes. Patients with locoregional advanced disease and poor performance status were excluded. All cases underwent standard one stage TLPO with bilateral inter-jugular lymph nodal clearance. Minimal invasive techniques used in three cases., Results: Out of 35 patients, n=21 (60%) of patient had lesion of hypopharynx with post cricoid involvement, n=13 (37.1%) had primary tumour of cervical oesophagus abutting pharynx and cricoid and only one patient had a tumour of hypopharynx with perforation. Histopathological conformation of diagnosis done in all patients preoperatively which showed Well differentiated Squamous cell in n=19 (54.28%), moderately differentiated squamous cell in 28.57% (n=10). Post-operative staging of the patients 74.28% (n=26) fall in stage 3. Operative time was less than 3 hours in 17 patients with two team technique, between 3-4 hours in 8 patients and more than 4 hours in 3 patients. SVT in 14.28% (n=5), Atrial Fibrillation in 5.71% (n=2). Chest complications including pneumothorax in 11.43% (n=4), basal atelectasis in 22.86% (n=8), pulmonary embolism in 2.85% (n=1), aspiration in 8.57% (n=3) and tracheal stenosis in n=1, 5.71% (n=2) cases had anastomotic leak. Postop 28 days mortality was 8.57% (n=3)., Conclusions: TLPO with stomach pull up offer good results in patients with resectable disease with acceptable morbidity and mortality in operable patients.

Background: Complications arising from anastomotic failure may occur after pharyngoesophageal reconstruction. In this report we present results of pharyngoesophageal reconstruction with free thigh flaps using a refined design and inset strategy in a series of patients., Methods: From May 2011 to December 2012, pharyngoesophageal oncologic defects were reconstructed in 12 men using thigh flaps. Flaps were designed to exceed defect circumference to allow draping of the excess over injury-prone vessels (so-called delta-inset). Patients were 39- to 68-years-old (mean, 51.8-years-old) at the time of surgery. BMI ranged from 17 to 28 kg/m 2 (average, 21.5 kg/m 2 ). The sites of defects were the hypopharynx in 11 cases and the pharynx in 1 case. Ten anterolateral thigh (ALT) flaps and 2 anteromedial thigh (AMT) flaps were used. All patients underwent radiation therapy., Results: The average flap size was 22 × 9 cm (range: 16-26 × 7-11 cm 2 ). There were no partial or total flap losses, and no donor site complications. Follow-up was 19.3 months (range: 2.4-21.6 months) including 8 patients (75%) who succumbed to disease in the follow-up period. Oral intake was achieved in all patients. Recipient site complications occurred in 50% of cases and included fistula (2 cases), fistula and stricture (2 cases), stricture (1 case), and lymphocele (1 case). Four patients required revision for fistula., Conclusions: A refined thigh flap design and inset method in pharyngoesophageal reconstruction may circumvent complications arising from toxic drainage and vascular injury. However, there are insufficient data to make meaningful comparisons to alternative methods. © 2015 Wiley Periodicals, Inc. Microsurgery 37:112-118, 2017., (© 2015 Wiley Periodicals, Inc.)

Objective: To evaluate the effect and feasibility of coblation treatment for laryngopharynx hemangioma., Method: Retrospectively analyzed 24 cases with coblation treatment for laryngopharynx hemangioma in recent years., Result: Twenty-four patients were treated with coblation, follow-ups range 6 months to 24 months after surgry. Recurrence occurred in 2 months after surgry in one patient who was cured with coblation for second time. There was incomplete vocal cord paralysis in another patient because of wide range angeioma., Conclusion: Coblation treatment for laryngopharynx hemangioma was an ideal way to less bleeding, less damage and more clearfield of vision.

Background: Partial hypopharyngeal defects are most commonly reconstructed with the pectoralis major myocutaneous flap (PMMF) or free fasciocutaneous (FFC) flap. The purpose of this study is to determine the ideal method for reconstruction of partial hypopharyngeal defects by reviewing our institutional experience and the literature., Methods: A retrospective review of partial hypopharyngeal reconstructions since 2009 was performed. A National Library of Medicine search of studies on partial hypopharyngeal reconstruction since 1988 was performed. Data on complications, diet, and speech were extracted and pooled., Results: A total of 18 patients were studied-9 had PMMF reconstruction and 9 had FFC reconstruction. Operative time (8.75 vs. 13.0 hours, p = 0.0003) was shorter in the PMMF group. Pharyngocutaneous fistula developed in one PMMF patient (11.1%) and two FFC patients (22.2%). Late strictures occurred in three PMMF patients. Six patients in each group (66.7%) progressed to a regular diet. Three patients in each group produced tracheoesophageal speech after TEP. Literature review identified 36 relevant studies, with 301 patients reconstructed with PMMF and 605 patients with FFC. Pooled-data analysis revealed that PMMF had higher reported rates of fistula (24.7 vs. 8.9%, p < 0.0001) and requirement for second surgery (11.3 vs. 5.5%, p = 0.04). There was no difference in stricture rates or progression to regular diet. Fewer PMMF patients produced tracheoesophageal speech (17.5 vs. 52.1%, p < 0.0001)., Conclusions: PMMF and FFC flaps are valid approaches to reconstructing partial hypopharyngeal defects, though rates in the literature of fistula, need for revisional surgery, and tracheoesophageal speech after laryngectomy are more favorable after free flap reconstruction., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Solitary fibrous tumors are rare mesenchymal neoplasms that are increasingly being described in the head and neck. Clinical presentations may include compression by these tumors on vital surrounding structures. While malignant transformation is rare, treatment entails wide local excision. We present the case of a 74 year-old female with an increasingly enlarging symptomatic hypopharyngeal solitary fibrous tumor that was found on carotid duplex ultrasound. Transoral surgical excision resulted in relief of symptoms. Treatment options are discussed and a literature review of this uncommon disorder presented., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Surgery for squamous cell carcinoma (SCC) arising or extending to the hypopharynx is generally reserved for advanced disease or salvage. The prognosis of patients requiring pharyngectomy is poor, and the perioperative morbidity is significant. The aim of the present study is to describe the disease-related and treatment-related outcomes of patients undergoing primary and salvage pharyngectomy for cancer of the hypopharynx and larynx over a 10-year period from a single institution., Methods: We retrospectively reviewed 138 partial and circumferential pharyngectomies performed at a tertiary referral center between 1992 and 2002. There were 31 females and 107 males. The median age was 62 years (range, 27-81 years), and mean follow-up was 3.6 years. Salvage pharyngectomy for radiation failure was performed in 72 patients (52%), and in 66 patients (48%) pharyngectomy was performed as the primary treatment., Results: The 5-year overall survival rate after salvage pharyngectomy was 31% and after primary pharyngectomy was 38%. The 5-year disease-specific survival (DSS) for salvage was 40% and after primary surgery was 45%. The 5-year local and regional control rates for salvage pharyngectomy were 71% and 70%, respectively, and for primary pharyngectomy were 79% and 67%, respectively. The perioperative mortality rate was 3.6%, and the combined morbidity rate was 70%. Postoperative hypocalcemia developed in 44% of patients, a pharyngocutaneous fistula developed in 31% of patients, and the long-term stricture rate was 15%. Variables adversely affecting DSS on univariate analysis were nodal metastases (p = .044), extracapsular spread (ECS) (p = .006), poorly differentiated tumors (p = .015), lymphovascular invasion (p = .042), and positive tumor margins (p = .026). ECS (p = .023) was the only independent prognostic variable on multivariable analysis; however, there was a trend toward significance for nodal metastases (p = .064) and tumor differentiation (p = .079)., Conclusion: This study demonstrates that both salvage pharyngectomy and primary surgery for advanced disease are viable options with high locoregional control. However, this represents a high-risk group in terms of both operative morbidity and survival. Patients with nodal metastases, ECS, and poorly differentiated tumors are likely to succumb to their disease and should be selected for adjuvant therapy when possible.

Purpose of the Study: To evaluate the clinical, radiological presentation and surgical management of fibrovascular polyps of the hypopharynx., Methods: Retrospective medical analysis of a case report. We report the case of a 66-year-old man, who presented with an incarcerated left inguinal hernia, vomiting and regurgitation of a large mass into the oral cavity resulting in syncope. MRI and cine-esophagram demonstrated a large mass in the cervical esophagus. At the time of herniorrhaphy, endoscopy revealed an 11.8-cm hypopharyngeal mass that completely obstructed the oropharynx., Results: The airway was secured by tracheostomy and the lesion was subsequently removed via open pharyngotomy. Postoperatively, a second polyp was found ball-valving into the airway, and an endoscopic resection was performed prior to decannulation. Histopathology of both lesions confirmed the diagnosis of a fibrovascular polyp., Conclusion: Fibrovascular polyps are rare benign intraluminal esophageal lesions resulting in mild symptoms of dysphagia that may also cause significant morbidity such as syncope and asphyxia. This is the first report of synchronous fibrovascular polyps of the hypopharynx., (Copyright (c) 2004 S. Karger AG, Basel.)

Hypopharynx and cervical esophagus represent a critical location for a squamous cell carcinoma, a neoplasm that usually requires extensive surgery. Although morbidity and mortality of resection have markedly decreased over the past decade, the major issue in these patients remains quality of life owing to the need for combination with a laryngectomy to provide radical treatment. Chemoradiation therapy has the potential to downstage and even cure the disease without altering quality of life dramatically. Today, in the absence of randomized trials, the choice between surgery and definitive chemoradiotherapy should be based on clear information and the patient's preference. Salvage surgery is feasible and effective in selected patients.

Reconstruction of the oro- and hypopharynx has specific difficulties duo to their wide diameters. Thirteen patients underwent reconstruction with a free U-shaped jejunal transplant, after circular pharyngo-laryngectomy for hypopharyngeal cancer invading the oropharynx. This transplant included a side-to-side anastomosis between the two limbs of the jejunal loop and allowed reconstruction of the upper digestive tract after wide carcinologic resection of the pharynx. The U-shaped jejunal transplant facilitated the upper anastomosis, especially the upper part where the resection involved the oropharynx. It formed a reservoir behind the tongue and avoided nasal reflux. Best indication are large resections involving the oropharynx.

Esopharyngolaryngeal resection for carcinoma of the cervical esophagus must be accompanied by resection of the thyroid gland, parathyroid bodies, and regional lymph nodes. In order to reduce long-term morbidity associated with the procedure, we performed parathyroid autotransplantation in two patients who underwent esophagolaryngeal resections. Grafting of the upper two parathyroid glands into the sternocleidomastoid muscle was carried out successfully in both cases. Graft function was rapidly restored. During the third postoperative week, blood levels of intact parathormone (PTH) reached 20 pg ml(-1) in the first case and 15 pg ml(-1) in the second, and the patients were successfully weaned off calcium and vitamin D supplementation. Parathyroid autotransplantation should be attempted in all cases of esophagolaryngeal resections provided that parathyroid glands are free of malignancy.

To approach the mechanism of hemilaryngeal fixation in pyriform sinus carcinoma (PSC), surgical specimens from total laryngectomy and partial hypopharyngectomy in 43 cases of pyriform sinus carcinoma were studied using organ subserial sections. Invasion of intralaryngeal muscles and the upper and outer aspects of arytenoid cartilage via paraglottic space was found to be the main cause of hemilaryngeal fixation in these cases. Presence of tumor on the medial wall of the pyriform sinus makes involvement of intralaryngeal structures easy, and thus is more frequently seen with hemilaryngeal fixation. Clinical T3 lesion of the sinus may infiltrate laryngeal cartilages and adjacent soft tissue to become pathologic T4 lesion. For PSC appearing hemilaryngeal fixation, total laryngectomy is safer to thoroughly remove cancer.

Patients with carcinoma of the hypopharynx or the cervical esophagus usually undergo total laryngectomy with hypopharyngo-esophagectomy and, consequently, lose the power of speech. Therefore, a reconstruction method which would enable speech rehabilitation is desirable following this type of procedure. Free ileocolon transfer consists of colo-esophagostomy, pharyngo-colostomy, ileo-tracheotomy, vascular anastomosis under a microscope, and permanent tracheostomy. In this method, the colon functions as the alimentary tract, while the ileum and ileocecal valve can produce sounds. We evaluated the results in live patients with free ileocolon transfer following hypopharyngo-laryngo-cervical esophagectomy. Although there was no case of direct operative death, one patient died from cancer progression. Four patients are still alive at from 18 to 36 months after operation. Postoperatively, stenosis of the colo-esophaogostomy appeared in two patients, but there was no case of anastomotic breakdown or any other major complication. Speech rehabilitation was good, and there was no misswallowing into the airway. We think that free ileocolon graft is one of the more preferable procedures following hypopharyngo-laryngo-cervical esophagectomy.

Despite progress in techniques for early detection and treatment of cancers, cases of multiple primary cancers are apparently increasing. This paper reported quadruple primary cancers of stomach, lung, hypopharynx and maxillary sinus in a 63-year-old male. He finally died of brain metastasis and pneumonia by MRSA (Me Resistant S. aureus).

We describe our experience using the Provox voice prosthesis in patients undergoing free jejunal loop transfer following total pharyngo-laryngectomy. From our series and the few reports in the literature, the use of a voice prosthesis appears to be an effective method of speech rehabilitation in this group of patients.

When resection of the posterior hypopharyngeal wall is undertaken for treatment of pyriform sinus carcinoma, a very narrow mucosal strip may be left for reconstruction. A surgical technique for carcinoma which has invaded the whole lateral hypopharyngeal wall is described. It consists of resecting half the larynx and half the hypopharynx and reconstructing the food canal using the mucosa of the unaffected half of the larynx and the remnant hypopharynx. A series of 34 patients treated by this technique is presented. No hypopharyngeal stenosis was observed. Local recurrences developed in 9 cases and distant metastases in 6. A specific disease mortality rate of 44% was encountered. At present, 15 patients are disease-free after a median follow-up of 48 months.

Hypopharynx repair following resection of a pyriform sinus carcinoma may be accomplished primarily or involve a more extensive procedure, such as a free intestinal graft. Described herein is a laryngeal flap which may be used to repair a hypopharyngeal defect when a strip of mucosa, too narrow for a primary repair, is left. This method has been used successfully in 4 patients and has saved these patients from more extensive repairs.

Reconstruction of the cervical esophagus is a problem in the surgical treatment of hypopharyngeal cancer. The conventional deltopectoral skin flap and the pectoralis major myocutaneous flap both have shortcomings. We developed a new technique for the immediate reconstruction of the entire cervical esophagus that utilizes the pectoralis major muscle with skin grafted directly onto it. This is especially useful in female patients who are buxom or have thick subcutaneous adipose tissue, because the anterior chest skin is not used as the skin island and, therefore, the flap is not too bulky and cosmetic problems are minimal. The breast is left unaffected with the nipple in its normal position. We report the technical details and the results in four female patients with hypopharyngeal cancer.

Experience with 22 cases of reconstruction of the cervical esophagus, hypopharynx and oral cavity using free jejunal transfer is presented. The method requires an experienced team with high technical competence, but the benefits related to rapid single-stage completion and low morbidity certainly justify its use.

Reconstruction of the pharynx and cervical esophagus is a surgical challenge associated with high complications, multiple-staged procedures, and prolonged hospitalizations. In a series of cases, single-stage transfer-free jejunal graft reconstructions had a 85% success rate with low complications in a series of patients who received preoperative, postoperative, and curative radiation treatment. There are advantages to this reconstruction procedure; however, there can also be complications.

Many different reconstructive procedures are available to the surgeon for restoration of a functioning conduit from the oral cavity to the esophagus. Most procedures require a lengthy single stage or multiple stages to complete reconstruction of the hypopharynx. The base of the tongue is a potential source for variously designed flaps that can be employed to reconstruct the hypopharynx following major resections. Because of proximity and rich vascularization of the tongue base, flaps fashioned from this region have proved to be very expedient and reliable in repair of large defects of the pharynx following subtotal laryngopharyngectomy and supraglottic laryngectomy.

Patients with extensive circumferential tumors of the hypopharynx and those with carcinomas of the cervical esophagus usually require resection of a cylindrical segment of the upper digestive tube. These patients present similar difficulties of reconstruction and also share a very poor prognosis. At times, the same complicated technical effort is required for palliation and definitive cure alike. From 1970 through 1982 at the University of Texas-M.D. Anderson Hospital at Houston, 78 patients underwent complete resection of the hypopharynx (54 patients) or the cervical esophagus (24 patients) for advanced malignant tumors. Seventy-three tumors were squamous cell carcinomas, and the remaining 5 were cancers that originated in the salivary gland. These large tumors were not staged according to the TNM system, since they frequently involved two different anatomic structures and a precise clinical assessment was not always possible. The only criterion for inclusion of patients in this series was the need to replace the entire pharynx or cervical esophagus after removal of the cancer. Of the 78 patients, 64 received their entire treatment at our institution, and of this group, 44 patients had only one surgical procedure. All patients in the series had circumferential resection as the final surgical step at our institution. The types of repair used in this group of patients were a cutaneous flap or graft in 44 patients, a colon bypass in 16 patients, a lateral trapezius musculocutaneous flap in 9 patients, and a pectoralis major musculocutaneous flap in 6 patients. In three additional patients, the reconstruction was initially delayed for various reasons and was ultimately abandoned. Technical considerations and a detailed analysis of the complications and palliative value of each procedure are presented. The merit of these procedures is judged according to the quality and the length of the patient's survival. Although the degree of palliation varies considerably according to the technique used, the survival rates were similar in all cases, the average being 43 percent at 5 years after the first treatment attempt and 27 percent at 5 years after the surgical resection that required a complete circumferential reconstruction.

Early hypopharyngeal carcinoma is a rare but difficult problem to handle. Early metastases, local recurrences, and mediastinal extension are the most common causes of failure. Radical surgery, preserving as much function as possible, and aggressive postoperative radiation are the hallmarks of management.

Most recent publications dealing with surgical repair following pharyngolaryngectomy or pharyngolaryngoesophagectomy appear to be based upon limited surgical experience of the most differing operations now available. An up to date review of 162 patients, including 68 gastric "pull up" procedures, has the advantage of being a personal series as well as a critical evaluation of each technique based upon personal evaluation.

Patients with hypopharynx carcinoma underwent planned irradiation and surgical treatment (pharyngo-laryngectomy with uni- or bilateral neck dissection) with postoperative planned irradiation. One group of these patients was treated with intraarterial chemotherapy with Methotrexat prior to any other therapy. The group with intraarterial therapy followed by irradiation seems to give the best results.

Conservation surgery for cancer of the larynx results in deglutition problems. Rehabilitation of swallowing function can successfully be managed by a team including a surgeon, a dietitian, and a nurse. This report details surgical reconstruction to prevent or treat aspiration, postsurgical dietetic management, and the nursing approach to deglutition training in a group of patients.

We have reviewed current thoughts on the diagnosis and treatment of cancer of the larynx and hypopharynx. Early diagnosis remains the key to successful treatment providing high cure rates and optimal function. Combined therapy (surgery, irradiation, and possibly adjuvant chemotherapy) is preferred in more advanced stage III and IV disease. Partial laryngectomies are oncologically sound when applied in appropriately selected patients and, when total laryngectomy is required, a simple endoscopic procedure has improved the outlook for speech rehabilitation. Reconstruction following laryngopharyngectomy has been strengthened by the advent of the myocutaneous flaps, and gastropharyngeal anastomosis provides for adequate excision of cancers involving the esophagus and immediate restoration of function.

A one-stage procedure to restore the cervical part of the esophagus and laryngopharynx included extended surgery for advanced cancer of the larynx and laryngopharynx and grafting a free revascularized small intestine segment using microvascular technique. Free small intestine transplant proved well-fed by sufficiently large branches of the external carotid artery, and normal venous drainage was retained. The transplant proved biologically best suitable for such type of plastic surgery. Treatment results should be considered promising.

Sixty-six patients with carcinoma of the hypopharynx or cervical esophagus received esophageal extraction and primary reconstruction. The methods of reconstruction were free forearm skin tube grafting, free jejunal transplantation and immediate pharyngo-gastrostomy after pull-through esophagectomy. Considering the postoperative complications of each method, free forearm skin tube transplantation is the safest, but it can only be used for a short defect of the esophagus. With pull-through esophagectomy, we are able to extract the whole esophagus and have no fear of leaving any remaining cancer in the thoracic esophagus, but the operative burden and the rate at which complications occur are higher. Free jejunal transplantation can be used for a short or long defect of the cervical esophagus with small operative burden. Among three methods of reconstruction, free jejunal transplantation is recommended for primary reconstruction of the cervical esophagus.

Since March 1978, conservative laryngopharyngeal surgery has been used in the treatment of carcinoma of the pyriform sinus at this hospital. For pharyngeal reconstruction, cervical skin flap, deltopectoral flap, free microvascular bowel transfer, and pectoralis major myocutaneous flap and gastric pull-up transfer were used. The remaining part of the larynx was repaired with cervical skin flap, sternohyoid myofascia, epiglottis or remnant of epiglottis for complete rehabilitation (phonation, deglutition protection and respiration) or partial rehabilitation (phonation and deglutition protection) of laryngeal functions. 47 patients with carcinoma of the pyriform sinus were treated, and fairly good results were obtained. The 5-year survival rate was 41.7%, and the 3-year survival rate 50%. The laryngeal function restored completely in 31 patients and partially in 16. It is suggested that preservation of the unaffected part of the larynx is feasible both for eradication of tumor and preservation of laryngeal function.

Between the years 1965 to 1977, 58 patients with advanced hypopharyngeal squamous carcinoma were treated by pharyngolaryngoesophagectomy and total thyroidectomy. Operative mortality for potentially curable cases was 8.6%, with a crude three-year survival rate of 29% for all cases. Mortality was 37% for patients with postcricoid tumors. Long-term management was uncomplicated except for calcium metabolism; two patients died from nephrocalcinosis secondary to return of circulating parathyroid hormone. I discuss the role of this operation in the successful treatment of hypopharyngeal cancer.

From 1978 through 1984, 120 patients with hypopharyngeal carcinomas were treated cooperatively by the University Hospitals of Erlangen. 120 out of these patients were men and 6 women. 96 patients (80%) suffered from cervical lymph node metastases, 91 (76%) were already in UICC stage IV. There were two cases with stage I, eight cases (7%) with stage II, and 19 cases (16%) with stage III. Among the 116 patients treated by causal therapy, 70 (60%) reached complete remission (CR), 34 (29.5%) partial remission (PR), and 12 (10.5%) were non-responders (NC,P). The cumulative survival at five years was 14% in 120 patients and 24% in 70 patients after CR. None of the patients with PR or NC survived more than two years. 111 patients were irradiated. Group 1: radiotherapy alone (41 patients), group 2: surgery and radiotherapy (47 patients), group 3: chemotherapy and radiotherapy (19 patients). The medium treatment period was 76, 107, and 141 days, respectively. The cumulative survival at five years was 3% in group 1, 28% in group 2, the survival at three years in group 3 was 14%. The results of postoperative radiotherapy, amounting to 36%, were better than the rate of 20% achieved by preoperative radiotherapy and surgery. A survival at five years of 46% was obtained after transoral microlaryngoscopic laser resection and postoperative irradiation, which was therefore superior to conventional operation techniques combined with radiotherapy (16%). Moreover, better functional and cosmetic results were achieved with this method. The prognosis is unfavorably influenced by a high stage, lymph node manifestations, and dedifferentiated tumor histology.

The synovial sarcoma is a mesenchymal tumour that is very rare in the head and neck region. This is a report on two cases. In a 30-year old patient the tumour arose near the thyroid gland and the hypopharynx. He died in spite of surgical removal, radiotherapy and chemotherapy, one year after the first symptoms. An 8-year old boy was affected by a synovial sarcoma near the hyoid bone and is without recurrence after surgical removal, radiotherapy and chemotherapy. Subsequently, the main diagnostic characteristics of these tumours are discussed. A better prognosis of the tumours associated with the hyoid bone is a remarkable fact.

Two further indications for the use of a musculocutaneous flap from pectoralis major are reported: mucosal reconstruction after posterior pharyngectomy and vertical hemi-laryngopharyngectomy. This method was used in 7 cases, after previous surgery in 6 of these patients. Caution is necessary when interpreting carcinologic results because of the lack of long-term follow up results, but postoperative course was uncomplicated and tube removal and subnormal feeding was possible within 3 to 6 weeks.

Treatment of hypopharyngeal carcinoma is difficult and frustrating due to notable problems in reconstruction and because of the low rate of healing. A review of the reconstruction techniques proposed over the last fifty years is given, particularly in regard to those using the residual larynx in reconstructing the alimentary canal. Wookey-type surgery provides for multiple stages and requires long hospital stays; even the reconstruction proposed by Bakamjian requires two operations and is often hampered by a distal necrosis of the deltopectoral flap. The one-stage reconstructions use the abdominal intestine, myocutaneous tubulized flaps and local mucosa flaps made of the tongue, epiglottis and residual larynx stripped of its cartilage. Those techniques using the abdominal intestine have an elevated rate of complications and per-operative mortality, while those using tubulized pectoral myocutaneous flaps at times compress the vascular peduncle due to their thickness, thus leading to post-operative stenosis. In the present work description is given of the hypopharyngeal reconstruction technique using the residual larynx stripped of its cartilage. In cases of cancer of the pyriform sinus the contralateral hemilarynx has been used while, in posterior tumors, the anterior larynx has been used, sutured to the residual posterior mucosa or to a myocutaneous flap. Nine patients underwent surgery using this technique; of these, seven had a tumor of the pyriform sinus, one a retrocricoid tumor and one carcinoma of the posterior wall of the hypopharynx. The oncological results do not appear much different than those obtained with the more well-known techniques, although follow-up is still too short.(ABSTRACT TRUNCATED AT 250 WORDS)

During the period between 1965 and 1983, 101 pharyngolaryngoesophagectomies with primary pharyngogastric anastomosis were carried out for primary hypopharyngeal cancer at The Royal National Throat, Nose and Ear Hospital, London, England. The Hospital mortality rate was 11%; postoperative complications such as pleural effusion and regurgitation of bile occurred in all patients. Successful swallowing occurred in all patients before they left the hospital--usually within 2 wk of surgery. An actuarial survival rate of 58% was obtained for the entire group.

A combination of total laryngopharyngectomy and primary reconstruction of the cervical esophagus is the operation of choice in the treatment of advanced hypopharyngeal cancer. For the excision, the most important task for the surgeon is to estimate the adequate safety margins superiorly and inferiorly. In order to ensure safer margins, animal experiments on lymph-flow in the submucosal layer of the hypopharyngeal cavity that is considered to be responsible for invisible submucosal invasion of cancer, were undertaken. Based on the results of both these experiments and clinical observations of many cases, it appeared most likely that cancers in the pyriform sinus or in the posterior wall tend to spread upward to the oropharyngeal cavity, while those in the postcricoid region have a tendency to invade in every direction but mainly downward to the cervical esophagus. In many cases, therefore, the cavity should be excised at a level just inferior to the palatine tonsil with a safety margin of more than 2 cm. The inferior excision level, on the other hand, should be decided according to whether the invasion extends beyond the level of the 7th cervical vertebra. When the tumor invades down to the level of the thoracic vertebrae, total esophagectomy should be indicated because of the high incidence of skip lesions in the lower esophagus. For better prognosis, bilateral neck dissection is recommended, since hypopharyngeal cancer has high (more than 30%) incidence of contralateral neck metastasis except for well differentiated T2 lesions in the pyriform sinus. For reconstruction of the cervical esophagus, a one-stage technique using a pectoralis major myocutaneous flap has many advantages over other options, and technical details are reported here in this paper. In some patients, however, this technique is not advisable. In female patients with large breasts or thick subcutaneous fat, the flap cannot be utilized because of its bulkiness, and a newly developed technique that uses a skin-grafted pectoralis major muscle flap is indicated. For patients with a history of heavy radiotherapy, the use of the flap is also contra-indicated because of the risk of salivary fistula, and a staged operation using a deltopectoral skin flap is recommended.