下咽頭・食道癌の治療 Ａ． 下咽頭癌の治療

Abstract

A total of 256 previously untreated patients with hypopharyngeal carcinoma from 1978 to 1990 were enrolled at our clinic, resulting in 194 piriform sinus type (PSC), 39 postcricoid type and 23 posterior wall type; 14 stage I, 33 stage II, 96 stage III and 113 stage IV. Therapeutic methods for them were radical in 211, palliative in 32 and no treatment in 13 mainly because of high age. Modalities of curative treatment were surgery in 178 (90 of them combined with radiation and/or chemotherapy), radiation in 30 and chemotherapy in 3. The crude 5-year-survival rates were 34.6% for the overall (n=253) and 40.2% (cause specific 49.9%) for curative treatment group (n=211). The surgery alone group and the postoperative radiation group had better prognosis than the preoperative radiation or chemotherapy group. From these results, we have performed surgery first when the combined therapy has been applied if necessary. At the resection of the lesion, we make efforts to preserve pharyngeal mucosa as much as possible with the margin of about 2 cm. Primary closure of the pharynx is performed, when the width of the mucosa is more than 2-3 cm, and the reconstruction by a forearm free skin flap, when less than it. In the case of circumferential mucosal defect, a free jejunum is used. Out of 138 PSC, 94 (68.1%) was possible to close the pharynx primarily. The second primary malignancies were found in 47 patients (18.4%) and the strict follow up is important especially for carcinoma of the esophagus, the mesopharynx or the lung, which have common risk factors of drinking or smoking.