Larynx preserving surgery in carcinomas of the posterior hypopharyngeal wall by reconstruction with a free flap

Abstract

In a series of 9 patients with advanced carcinomas of the posterior wall of the hypopharynx (2 patients with T2 tumors and 7 patients with T4 disease), we tried to preserve the larynx with surgical therapy. The concept of laryngeal preservation consisted of lateral pharyngotomy with free flap reconstruction of the defect created by the tumor resection. A recommendation for surgery was given to each patient with a neoplasm in the posterior pharyngeal wall and tumor extension > 6 cm in diameter. The maximum tumor diameters ranged between 6.5 cm and 12.5 cm. Reconstruction was performed in 8 cases with radial forearm flaps while a jejunal transplant was used in one case due to the extension of tumor. During each surgical procedure an attempt was made to preserve the superior laryngeal nerves and transplants were adapted exactly to the resection defects. Seven patients achieved oral swallowing within three months of surgery, while one patient needed four months to swallow orally. One patient had persistent aspiration and still needs a percutaneous gastrostomy. Six patients were decannulated successfully, so that laryngectomy was avoided during postoperative follow-up. These results show that surgical therapy of advanced carcinoma of the posterior wall of the hypopharynx is possible with preservation of the larynx. Additionally, functional outcome after treatment of these patients with free flap reconstruction is comparable to other treatment modalities, such as radiochemotherapy.