Pyriform Sinus Cancer Research Articles

Application of folded flap in laryngeal and hypopharyngeal function reconstructions after surgery of piriform sinus cancer

Objective: To investigate the use of folded flap for repair of laryngeal and hypopharyngeal defect and the clinical efficacies of laryngeal and hypopharyngeal function reconstructions after surgery of piriform sinus cancer. Methods: A retrospective analysis was performed for 10 cases of piriform sinus cancer that were treated in the Second Norman Bethune Hospital of Jilin University from January 2020 to April 2023 and all patients were males, aged 42-68 years. The first choice of treatment for all patients was surgery. After function neck dissection and tracheotomy, partial laryngectomy and hypopharyngectomy were carried out. The folded island flaps were prepared and used for the repairs of laryngeal and hypopharyngeal defects and the reconstructions laryngeal and hypopharyngeal functions. The patients were followed up. Results: The laryngeal and pharyngeal cavities were reconstructed well in 10 patients, and all the flaps survived, with no case of pharyngeal fistula. All patients were able to eat normally through the mouth at 2 weeks after surgery without obvious choking, and 4 patients completed the swallowing function evaluation without aspiration or only a small amount of aspiration. All the 10 patients underwent postoperative radiotherapy. The postoperative follow-up time was 5.4-41.4 months, and there was no case with tumor recurrence or death. Laryngoscopy showed that 8 patients had a spacious new laryngeal orifice, which met the conditions for extubation, of whom 7 patients had their tracheal tubes removed and 1 patient was still under observation, and that 2 patients had a slightly narrowed new laryngeal orifice due to a thick skin flap, with further follow-up observation. All patients retained their phonatory functions after surgery. Conclusion: Folded island flap can be used for the function reconstructions of the larynx and hypopharynx after surgery of pyriform sinus cancer.

A domain knowledge enhanced yield based deep learning classifier identifies perineural invasion in oral cavity squamous cell carcinoma.

Perineural invasion (PNI), a form of local invasion defined as the ability of cancer cells to invade in, around, and through nerves, has a negative prognostic impact in oral cavity squamous cell carcinoma (OCSCC). Unfortunately, the diagnosis of PNI suffers from a significant degree of intra- and interobserver variability. The aim of this pilot study was to develop a deep learning-based human-enhanced tool, termed domain knowledge enhanced yield (Domain-KEY) algorithm, for identifying PNI in digital slides. Hematoxylin and eosin (H&E)-stained whole-slide images (WSIs, n = 85) were obtained from 80 patients with OCSCC. The model structure consisted of two parts to simulate human decision-making skills in diagnostic pathology. To this aim, two semantic segmentation models were constructed (i.e., identification of nerve fibers followed by the diagnosis of PNI). The inferred results were subsequently subjected to post-processing of generated decision rules for diagnostic labeling. Ten H&E-stained WSIs not previously used in the study were read and labeled by the Domain-KEY algorithm. Thereafter, labeling correctness was visually inspected by two independent pathologists. The Domain-KEY algorithm was found to outperform the ResnetV2_50 classifier for the detection of PNI (diagnostic accuracy: 89.01% and 61.94%, respectively). On analyzing WSIs, the algorithm achieved a mean diagnostic accuracy as high as 97.50% versus traditional pathology. The observed accuracy in a validation dataset of 25 WSIs obtained from seven patients with oropharyngeal (cancer of the tongue base, n = 1; tonsil cancer, n = 1; soft palate cancer, n = 1) and hypopharyngeal (cancer of posterior wall, n = 2; pyriform sinus cancer, n = 2) malignancies was 96%. Notably, the algorithm was successfully applied in the analysis of WSIs to shorten the time required to reach a diagnosis. The addition of the hybrid intelligence model decreased the mean time required to reach a diagnosis by 15.0% and 23.7% for the first and second pathologists, respectively. On analyzing digital slides, the tool was effective in supporting human diagnostic thinking. The Domain-KEY algorithm successfully mimicked human decision-making skills and supported expert pathologists in the routine diagnosis of PNI.

Lymph node ratio predicts recurrence-free survival and disease-specific survival of patients with pyriform sinus squamous cell carcinoma

ObjectiveThis study assessed positive lymph node ratio (LNR) as a prognostic marker for patients with pyriform sinus cancer. MethodsThe present study retrospectively analyzed 101 patients with pyriform sinus cancer to determine the association of LNR with recurrence-free survival (RFS) and disease-specific survival (DSS). ResultsThe patients were followed up for a median duration of 28 months (range: 6–196 months). The number of median dissected lymph nodes (LNs) was 41, and the number of median positive LNs was three. The receiver operating characteristic curve revealed an LNR cut-off value of 8.6%. Lymphovascular invasion (LVI) or perineural invasion (PNI) (P = 0.001), thyroid gland invasion (TGI, P = 0.000), positive LNs >4 (P = 0.036), and LNR >8.6% (P = 0.008) were significantly associated with poor RFS, and LVI or PNI (P = 0.005), tumor pT3/T4 stage (P = 0.028), positive LNs >4 (P = 0.033), TGI (P = 0.001), and LNR >8.6% (P = 0.003) were significantly associated with poor DSS. The multivariate analysis revealed that LVI or PNI (P = 0.010), TGI (P = 0.000), and LNR >8.6% (P = 0.022) were independent predictors for poor RFS, while tumor pT3/T4 stage (P = 0.049), TGI (P = 0.015), and LNR >8.6% (P = 0.001) were independent predictors for poor DDS. ConclusionLNR and other clinicopathological data can be used to predict the RFS and DSS of pyriform sinus cancer patients.

Organ preservation surgery for pyriform sinus carcinoma with vocal cord fixation: functional and oncological outcomes.

Pyriform sinus carcinoma with vocal cord fixation is stratified as stage T3 and above, and non-surgical treatment is generally preferred according to the guidelines, aiming to preserve laryngeal function. However, long-term survival is often compromised by deep infiltration of the tumor. Vertical hemipharyngolaryngectomy (VHPL) was previously reported to be a feasible surgical approach for organ preservation. The aim of this study was to evaluate the functional and oncological outcomes of VHPL in patients. Patients who underwent VHPL type II (total VHPL, which includes the removal of a vertical section of the thyroid cartilage through the anterior commissure to the upper border of the cricoid cartilage) for pyriform sinus cancer with vocal cord fixation at the authors' institute between 1999 and 2015 were retrospectively analyzed. Functional outcomes concerning swallowing and decannulation were evaluated. Successful functional preservation was defined as laryngeal preservation as well as oral realimentation and decannulation within 6months after surgery. The oncological outcomes were measured by overall survival (OS) and disease-free survival (DFS) with Kaplan-Meier curves and comparisons were performed between the VHPL-treated patients and patients who underwent non-surgical treatment within the same period. A total of 23 patients (stage T3, 17 patients; stage T4, 6 patients) whose initial treatment was VHPL type II were studied, and a cohort of 123 patients was selected as the control group. Pedicle and free flap reconstructions were performed on 12 and 11 patients, respectively. Postoperative radiation and chemoradiation was performed on 14 and 3 patients, respectively. Flap failure and pharyngeal fistula were detected in 2 and 5 patients, respectively. Oral realimentation and decannulation within 6months were achieved in 82.6% (19 patients) and 87.0% (20 patients) of patients, respectively, and the total functional preservation rate of the study cohort at 6months was similar to that of the control cohort. (78.3% vs. 82.9%, p = 0.28). After a median follow-up period of 49months, 9 recurrences and 8 deaths had occurred in the study cohort. According to the Kaplan-Meier analysis, the study cohort had superior DFS (5-year DFS 60.3% vs. 44.6%, p = 0.04) and similar OS (5-year OS 63.8% vs 57.0% p = 0.28) compared with those in the control group. VHPL yielded favorable oncological and functional outcomes in patients with unilateral pyriform sinus carcinoma and vocal cord fixation.

Outcomes of Patients Undergoing Emergency Tracheostomy During COVID 19 Pandemic: Our Experience from a Tertiary Care Centre in North-East India.

Airway management in the form of tracheostomy may be done as an emergency or elective procedure depending on when the patient presents and it usually involves a multi-disciplinary team including the anesthesiologist and emergency physician. The purpose of this study is to present our experience with emergency tracheostomies carried out for patients presenting with tumors in the aerodigestive tract during this period of covid 19 pandemic and their outcomes. This is a cross sectional observational study. All the patients who underwent emergency tracheostomy at Dr. B. Borooah Cancer Institute, Guwahati, India, during the period 24th March, 2020 to 23rd September, 2020(6 months) are included in this study. A total of 115 patients underwent 117 emergency tracheostomies (two underwent redo tracheostomies). Median age of patients was 55 years. More than 85% of patients were male. The most common initial presenting complaint was dysphagia (40%) followed by dyspnea (25%). Most common site of tumor was pyriform sinus cancer (45.2%). Almost 45% of patients presented with stage IVA. Complications were seen in 10 patients (8.7%). These included stomal stenosis in 4(3.5%), primary hemorrhage in 3(2.6%), subcutaneous emphysema, infection and wound break down each in one patient (0.9% each). Among the eight residents who performed these procedures, five developed covid 19 symptoms subsequently, and were tested covid positive. Emergency tracheostomy is a safe procedure for patients; however it carries a higher risk of covid transmission despite using proper precautions.

Options of medical treatment and laryngeal function preservation in elderly patients with medial wall pyriform sinus cancer.

ObjectiveTo retrospectively investigate the clinical efficacy and larynx preservation of two different treatments: radiotherapy followed by surgery (R+S) and surgery followed by radiotherapy (S+R), in elderly patients with medial wall pyriform sinus cancer.Materials and methodsMedical records from 48 patients over 70 years old with medial wall pyriform sinus cancer who underwent different treatments between 2001 and 2010 were analyzed. Twenty-one patients underwent radiotherapy first followed by surgery (R+S), and the other 27 patients underwent surgery first followed by radiotherapy (S+R). A Kaplan–Meier method was used to calculate the survival rate.ResultsOverall 3-year and 5-year survival rates were 60.4% and 35.4%, respectively. The 5-year survival rates in R+S group and S+R group were 38.1% and 33.3%, respectively, without a statistically significant difference between the two groups (P>0.05). Also, comparisons of the decannulation rates (64.3% for R+S group vs 50.0% for S+R group) and postoperative complication rates (42.9% for R+S group vs 37.0% for S+R group) between the two groups of patients did not show obvious differences. However, the laryngeal preservation rates in R+S group and S+R group were 66.7% and 37.0%, respectively, with significantly statistical difference between the two groups (P<0.05).ConclusionBased on the data analysis of 48 patients, the survival rates of elderly patients who underwent R+S or S+R were comparable, but R+S treatment could improve the laryngeal preservation rate of patients. Further study on large-scale sample pool should be performed to confirm this conclusion.

Smokeless Tobacco: An Etiological Risk Factor for High Incidence of Pyriform Sinus Cancer in Assam, India

Background: Cancer incidence in northeast India including Assam state is higher than the Indian national average. The incidence of hypopharyngeal cancer mainly pyriform sinus is high in (14.7/100,000) Assam and other northeastern state like Meghalaya (East Khasi Hills). Recently published Global Adult Tobacco Survey (GATS 2) report has shown that there is a decrease in tobacco consumption in India from 34.6% to 28.6%. However, in Assam the rate has increased from 39.3% to 48.2% mainly in the form of smokeless tobacco. Cigarette smoker reduce from 8.8% (GATS 1, 2009-10) to 6.1% (GATS 2, 2017), but smokeless users increase from 32.7% (GATS 1, 2009-10) to 41.7% (GATS 2, 2017). By now in India we only have gutka and pan masala (Prohibition) act 2015, by which there is ban on gutka but not other smokeless tobacco product. Because of COTPA (Cigarettes-and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, there is reduction of smoking in India as well as in the state of Assam. But as we don't have stringent laws to control the use of smokeless tobacco, the users are increasing. Aim: To study the role of smokeless tobacco as a substantial etiological risk factor for high incidence of pyriform sinus cancer in Assam and to advocate for a strict law to prohibit or ban of smokeless tobacco in Assam. Methods: This is a retrospective study archived from hospital cancer registry database. 708 patients diagnosed with pyriform sinus carcinoma from January 2016 to December 2016 were analyzed. The relation between forms of tobacco use and gender, age group, place of residence and level of education were analyzed using IBM SPSS version 19. P &lt; 0.05 was considered as statistically significant. Results: 584 (82.5%) patients had the habit of tobacco consumption of whom 128 (21.9%) were smokers, 220 (37.6%) consumed smokeless tobacco and the remaining 237 (40.5%) cases consumed both forms of tobacco products. Forms of tobacco use differ significantly with patient's gender ( P &lt; 0.05). The patients in the age group ≥ 50 years or above 50 years, the highest frequency was observed in both forms of tobacco consumption (61/144 = 42.4% and 176/441 = 39.9%) respectively. Most of the patients from rural areas were habituated to both forms of tobacco use (201/499 = 40.3%) and most of them are mainly smokeless tobacco user. Conclusion: The current study shows that the incidence of smokeless tobacco user is alarmingly increasing in Assam and the northeastern part of India leading to high incidence of hypopharyngeal cancers. At present only gutka is banned in the India. So, further policies should be implemented to bring down the use of smokeless tobacco and thus reducing the burden of hypopharyngeal cancer in this part of the country.

Oncological and functional outcomes of trans-oral robotic surgery for pyriform sinus carcinoma: A French GETTEC group study

BackgroundPyriform sinus carcinomas (SCC) present specific functional and oncological issues. The recent advent of trans-oral robotic surgery (TORS), as a conservative procedure, has opened up new perspectives. ObjectivesTo present the oncological and functional outcomes of TORS for pyriform sinus SCC. Materials and methodsWe included, retrospectively, all TORS procedures for pyriform sinus SCC performed between 2009 and 2017 in eight French tertiary referral centers. We excluded lesions involving the pyriform sinus that had developed from the oropharynx, larynx, or other anatomic sub-sites of the hypopharynx. ResultsWe included 57 TORS procedures. Median hospital stay was 10 days. A preventive tracheotomy was performed in seven cases (12%), and all were successfully decannulated. Oral re-feeding was possible for 93%, after a median of 5 days. The main surgical complications were hemorrhages (three cases), all successfully handled, although 2 patients with heavy comorbidities died from blood loss in the days after. Adjuvant therapy was proposed in 31 cases (54%), including two cases of salvage surgery (total pharyngolaryngectomy). After a median follow-up of 23 months, overall and disease-free survival were, respectively, 84% and 74% at 24 months, and 66% and 50% at 48 months. At the end of follow-up, organ preservation rate was 96%. None of the surviving patients needed a tracheotomy and oral diet was possible for 96%. ConclusionThe functional and oncological outcomes of TORS for pyriform sinus cancer are encouraging, and this procedure can be considered safe for selected early or moderately advanced cases as a conservative treatment.

Combined transoral–transhyoid endoscopic approach for hypopharyngeal cancer

Endoscopic transoral surgery for hypopharyngeal cancer is an effective treatment option to avoid invasive open surgery or chemoradiation. Here we describe the case of a 66-year-old patient with cT2N0M0 pyriform sinus cancer whom we treated using a transoral–transhyoid endoscopic approach. Using this approach, a transhyoid route was created in addition to the transoral route and used to extirpate the tumor. En bloc resection of the tumor was completed without difficulty. A combined transoral–transhyoid approach is a useful surgical option for treatment of selected patients with hypopharyngeal cancer. This technique is straightforward to perform and can be used as a backup technique in endoscopic transoral surgery. Also, more complicated lesions can be resected by this approach than by a single-route transoral approach.

Surgical management of elderly patients with medial wall pyriform sinus cancer

Objective: To investigate the clinical efficacy of preoperative-, postoperative-radiotherapy and surgery for preserving laryngeal function in patient over 70 years of age with medial wall pyriform sinus cancer. Methods: Clinical data of 48 patients over 70 years of age with medial wall pyriform sinus cancer who received surgical treatment from January 2001 to December 2010 were retrospectively analyzed. Among them, 21 cases were given preoperative radiotherapy and surgery (R+ S). The radiation therapy dose was 45 Gy. And 14 cases' larynx is preserved. In addition, 27 cases were given postoperative radiotherapy and surgery (S+ R). The radiation therapy dose was 65 Gy. And 10 cases had preserved laryngeal function. Survival rates were analyzed by the Kaplan-Meier method. Chi-square test was used to compare complications between two groups. Results: The larynx preservation rate in R+ S group [66.7% (14/21)] was significantly higher than that in S+ R group [37.0% (10/27), P<0.05]. The complication rate and decannulation rate in R+ S group were 42.9% (9/21) and 64.3% (9/14), respectively, showing no difference compared with those in S+ R group [37.0% (10/27) and 50.0% (5/10), respectively] (all P>0.05). The complication rates of patients with and without larynx preservation were 41.7% (10/24) and 37.5% (9/24), respectively, showing no difference between two groups (P>0.05). The overall 3-years and 5-years survival rates for all patients were 54.2% (26/48) and 35.4% (17/48), respectively. There was no significant difference in survival rates between R+ S [38.1% (8/21)] group and S+ R group [33.3% (9/27), P>0.05)]. In the R+ S group, the survival rates in patients with and without larynx preservation were 40.0% (4/10) and 29.4% (5/17), respectively, showing no significant difference between two groups (P>0.05). Conclusions: It is secure and effective to choose the operation with laryngeal preservation for patient over 70 years of age with medial wall pyriform sinus cancer based on their physical conditions and the tumor extension. The preoperative- and postoperative-radiotherapy have the similar effect. Preoperative radiotherapy and surgery increases the laryngeal preservation rate.

Therapeutic Management of Pyriform Sinus Cancer.

Objective To analyze the survival rate of a nonselected pyriform sinus cancer population. Study Design Case series with chart review. Setting University hospital. Subjects and Methods A total of 122 patients were included in this study covering the 2002-2008 period. All patients had squamous cell carcinoma originating from the pyriform sinus. Survival and prognostic factors were analyzed. Results The 3- and 5-year overall survival rates were 39.7% and 2.4%, respectively. The 3- and 5-year survival rates without recurrence were 34% and 27%, respectively. The median survival rates by UICC stage were as follows: stage 1 and 2 patients, 60 months; stage 3, 40 months; stage 4, 19 months. Stage 4 patients had a lower median survival rate than other stages ( P = .039). The 5-year survival rate was 46% for patients having T3-T4 operable cancers treated by surgery vs 45% for patients treated by laryngeal conservation protocol (not significant). The 5-year survival rate for patients having nonoperable T4 cancers was 17.2%. The 3- and 5-year overall survival rates of N0 patients was significantly higher than N1 patients ( P = .042). N2 and N3 patients had 100% 5-year mortality. Conclusion This study showed that overall survival and therapeutic management depend on the initial stage of pyriform sinus cancer, notably on the N status. In particular, nonoperable T4 pyriform sinus cancer and N2 and N3 patients had a very poor prognosis. A laryngeal conservation protocol seemed as effective as surgical management in terms of survival.

Transoral robotic surgery for early T classification hypopharyngeal cancer.

For hypopharyngeal cancer, transoral robotic surgery (TORS) has been reported as a new organ preserving treatment but outcomes are rarely reported. From 2010 to 2013, 10 patients with early T classification pyriform sinus cancer were selected to receive TORS and conventional neck dissection. The clinical parameters, including rates of adjuvant radiotherapy, survivals, as well as organ and function preservation, were retrospectively analyzed. TORS was successful in all 10 patients, and 5 patients received adjuvant radiotherapy. After mean follow-up of 26 months, 1 patient died of distant metastasis and 1 patient died of other malignancy. There was no local recurrence and larynxes were all preserved. Eight surviving patients who were followed up continuously could receive oral intake and had a serviceable voice without tracheostomy or feeding tubes. TORS is a feasible transoral approach for selected patients with early T classification hypopharyngeal cancer. The reported oncologic/functional outcomes are satisfactory. © 2015 Wiley Periodicals, Inc. Head Neck 38: 857-862, 2016.

Priority Claim to "Sentinel Lymph Node Transfer".

Dear Editor-in-Chief Yong-Ha Kim, We have read the paper of Nicoli et al. [1] on potential use of transferred lymph nodes as detectors. It was an interesting case report stating that vascularized lymph nodes that were transplanted after tumor resection could be detectors of tumor metastasis. It also reported the postoperative findings of positron emission tomography-computed tomography to evaluate whether there was a or not. Although we commend them for their work, we would like to point out that we have already reported the same concept as lymph network reconstruction [2]. In this case report, we introduced a case of epihypopharyngeal pyriform sinus cancer, for which epi- and mesopharyngeal resection and simultaneous reconstruction were performed. A left superficial circumflex iliac artery perforator (SCIP) flap was used for reconstruction, and the flap contained two lymph nodes. In the pathological examination of the transferred SCIP flap, we found that a greater number of lymphatic vessels were present in the SCIP flap than the anterolateral thigh flap that was taken from another patient (lymphatic vessel endothelial hyaluronan receptor-1 staining). In our case, like Nicoli's cases, no evidence of has been detected for 1 year postoperatively. Nicoli's paper also presented postoperative indocyanine green (ICG) lymphography findings of one case, in which distally injected ICG flowed into the transferred flap. This showed the lymphatic connection of the recipient site and transferred flap, which should have a profound meaning in terms of the concept of the metastasis detector of lymph node reconstruction. As we stated in our paper, reconstruction of the sentinel lymph node system by lymph node transfer may allow establishment of a system for screening in cancer recurrence. We hope that this concept will be applied to many other patients in the future and that the technique will be beneficial to them.

Clinical outcomes of weekly cisplatin chemoradiotherapy for patients with pyriform sinus cancer.

Pyriform sinus squamous cell carcinoma (SCC) has one of the worst prognoses of all upper aerodigestive tract cancers. Improving clinical outcomes for patients with hypopharyngeal SCC has been particularly challenging for head and neck surgeons and oncologists. We investigated 30 patients with pyriform sinus SCC to verify the effectiveness of weekly cisplatin chemotherapy with concurrent radiotherapy. Cisplatin was administered at a dose of 40 mg/m(2) on weeks 1, 2, 3, 5, 6, and 7 during definitive radiotherapy with the aim of preserving the larynx. All 30 patients achieved definitive radiotherapy at a median dose of 70 Gy (range 64-70 Gy). Cisplatin was administrated concomitantly a median of five times (range 2-6 times). Persistent or recurrent primary disease was observed in four patients (13 %). Persistent or recurrent nodal metastasis was observed in five patients (17 %). Nine salvage surgeries were performed for eight patients, of whom seven survived without any evidence of disease. Post-operative complications were observed in two patients (22 %). The 5-year overall survival and locoregional control rates were 87 and 96 %, respectively. The 5-year laryngeal preservation rate was 74 %. The regimen of weekly cisplatin CRT may be effective for pyriform sinus SCC; however, there were problems with strong selection bias in the current study due to the large number of T2 patients. Salvage surgery was safe and was able to improve the survival rate. This chemoradiation regimen was considered successful in preserving laryngeal function.

A pyriform sinus cancer organ preservation strategy comprising induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil, followed by potentiated radiotherapy: a multicenter, retrospective study.

No specific study has evaluated the role of neoadjuvant DCF (docetaxel, cisplatin, 5-fluorouracil) followed by radiotherapy in pyriform sinus cancer, which are often included in studies focusing on laryngeal and hypopharyngeal cancer. We assessed the proportion of patients treated sequentially for a pyriform sinus cancer with a preserved larynx. Overall survival, event-free survival (EFS), survival with 'local control', and treatment tolerance were assessed as well. We retrospectively reviewed 88 patients with advanced pyriform sinus squamous cell carcinoma treated with DCF between 2005 and 2010. After induction, radiation could be potentiated with cetuximab or cisplatin. Most patients (82%) had been treated with organ preservation intent. The response rate to DCF was 85%, including 42% with complete response. Primary tumor was operated in 13 patients (eight with total laryngectomy). Radiotherapy had been delivered to 78 (89%) patients (30 with cisplatin, 39 with cetuximab). Potentiation had been achieved as planned in 52 and 79% of patients treated with cisplatin and cetuximab, respectively. Twenty-three local and three neck recurrences were found. Median overall survival was 16.8 months and 38.3% at 3 years. EFS at 3 years was 29.1% with a hazard ratio for partial responders versus nonresponders of 0.18 (P<0.001), and 0.13 (P<0.001) for complete responders versus nonresponders. Thirty-five percent of patients were alive with their larynx preserved at 3 years. This study confirms the efficacy of induction followed by chemoradiation for pyriform sinus cancer and that response to DCF is predictive of EFS.

Characteristics and Prognostic Implications of High-Risk HPV-Associated Hypopharyngeal Cancers

BackgroundHigh-risk human papillomavirus (HPV) is an oncogenic virus that causes oropharyngeal cancers, and it has a favorable outcome after the treatment. Unlike in oropharyngeal cancer, the prevalence and role of high-risk HPV in the etiology of hypopharyngeal squamous cell carcinoma (HPSCC) is uncertain.ObjectiveThe aim of the present study was to evaluate the effect and prognostic significance of high-risk HPV in patients with HPSCC.MethodsThe study included 64 subjects with HPSCC who underwent radical surgery with or without radiation-based adjuvant therapy. Primary tumor sites were the pyriform sinus in 42 patients, posterior pharyngeal wall in 19 patients, and postcricoid area in 3 patients. High-risk HPV in situ hybridization was performed to detect HPV infection.ResultsThe positive rate of high-risk HPV in situ hybridization was 10.9% (7/64). There was a significant difference in the fraction of positive high-risk HPV among pyriform sinus cancer (16.7%), posterior pharyngeal wall cancer (0%), and postcricoid area cancer (0%) (p = 0.042). The laryngoscopic examination revealed a granulomatous and exophytic appearance in 85.7% (6/7) of patients with high-risk HPV-positive pyriform sinus cancer, but in only 31.4% (11/35) of patients with high-risk HPV-negative pyriform sinus cancer (p = 0.012). Significant correlations were found between positive high-risk HPV and younger age (p = 0.050) and non-smoking status (p = 0.017). HPV-positive patients had a significantly better disease-free survival (p = 0.026) and disease-specific survival (p = 0.047) than HPV-negative patients.ConclusionsHigh-risk HPV infection is significantly related to pyriform sinus cancer in patients with HPSCC.

Treatment of pyriform sinus carcinoma involving the lateral wall

To present and discuss the clinical features, treatment, and efficacy of pyriform sinus carcinoma involving the lateral wall. Seventy-seven patients with pyriform sinus cancer involving the lateral wall (stage I 8, stage II 10, stage III 32, stage IV 27, according to UICC 2002 staging) were treated from Jun 1997 to Jun 2009 in the department of otorhinolaryngology head and neck surgery, Yuhuangding Hospital. The patients were divided into two groups: Group one 17 cases, simply underwent radiation therapy (R group); Group two 60 cases underwent surgery plus postoperative radiation (SR group). All patients underwent radiotherapy 50-75 Gy. In SR group, hyoid area and lateral pharyngeal approaches were taken according to the lesions for resection. To repair the defects and reconstruct the functions of larynx and pharynx, regional roping in suture, fascial flap/muscular- fascial of strap muscles, glosso-flap, musculocutaneous flap of major pectoral muscle, joint split graft or heterologous (bovine) acellular dermal matrix were used respectively. In group R, the primary tumor and neck lymph node metastasis disappeared at the end of radiotherapy in 15 cases. For one case, the N3 cervical lymph nodes shrank, but failed in local control and died of systemic metastases after 7 months. For another case, the N2 neck lymph nodes significantly reduced after the full course of radiation, PET-CT and biopsy did not find the cancer, but the tumor grew again after 6 months, and died of a neck bleeding 11 months later. All repairing materials used were alive in SR group. Two cases developed postoperative wound infection, and 2 cases suffered from pharyngeal fistula. All patients retained laryngeal functions, and all patients in SR group recovered diet 12 - 30 days, the mean time was 15.6 days. Three and 5 year survival rates for all 77 patients were 59.1% and 41.4%. For stage I + stage II cases in SR group and R group, 3 and 5 year survival rates were 63.6%, 53.0% and 66.7%, 50.0% respectively. There was no significant difference between the two groups (χ(2) = 0.021, P = 0.884). For cases of stage III + stage IV of the SR group and R group, 3 and 5 year survival rates were 63.9%, 43.7%, 16.4%, and 0. There was a very significant difference (χ(2) = 20.496, P = 0.000); all cases in SR group and in R group for 3, 5-year survival rates were 63.6%, 45.8%, 41.5%, and 24.9% respectively. There was also a significant stastical difference (χ(2) = 4.644, P = 0.031). Pyriform sinus carcinoma involving the lateral wall is characterized with scattered growth on the surface of mucous or submucously, tending to invade lamina cartilaginis thyroidea. Simple radiotherapy can get better therapeutic effect for early stage cases. The comprehensive therapy measures should be taken in advanced cases, especially those with surgical indications should be taken to surgery plus radiotherapy. For the purpose of excising the tumor thoroughly and preserving good laryngeal functions, proper operative approaches and ways of repairing should be selected.

Pyriform Sinus Cancer in the US: A Population-based Study of 5601 Patients Over 3 Decades

Pyriform Sinus Cancer in the US: A Population-based Study of 5601 Patients Over 3 Decades

Free Jejunal Graft for Esophageal Reconstruction Using End-to-Side Vascular Anastomosis and Extended Pharyngo-Jejunostomy

Pharyngo-esophageal reconstruction using free jejunal grafts (FJGs) has been widely used, but the procedure is technically demanding and requires the involvement of multiple departments. We performed simplified reconstruction with FJGs using end-to-side vascular anastomosis and extended pharyngo-jejunostomy. The jejunal artery and vein were anastomosed to the neck vessels in an end-to-side fashion without microvascular anastomosis. Pharyngo-jejunostomy with extended end-to-end anastomosis was performed to reduce size mismatch. We retrospectively analyzed the medical records of 32 patients diagnosed with pharyngeal, esophageal, or pyriform sinus cancer who received a FJG. The mean age was 61.5±9.4 years, and there were 25 male patients. Jejunal vessels were commonly anastomosed to the right common carotid artery and the right internal jugular vein (22, 68.8%). The mean ischemic times of the FJG and carotid artery clamping time were 46.5±8.1 and 15.8±4.4 minutes, respectively. During the procedure, 3 patients suffered from inadequate reperfusion of the FJG requiring removal of the initial graft and replacement with another FJG. There were no neurologic complications, postoperative deaths, or adverse events directly related to FJG except for leakage of the pharyngo-jejunostomy site in 1 patient, which was primarily repaired. During the follow-up period, 5 patients (15.6%) suffered from dysphagia, but only 3 patients had evidence of anastomotic strictures at the jejuno-esophagostomy site. Thirteen patients (40.6%) received postoperative adjuvant radiotherapy. Our technique of FJG with end-to-side vascular anastomosis and extended pharyngo-jejunostomy is simple and safe.

Necessity of routine ipsilateral hemithyroidectomy during laryngopharyngectomy for pyriform sinus cancer

PurposeThe aim of this study was to revisit the role of hemithyroidectomy in the treatment of pyriform sinus cancer by determining the incidence of thyroid gland invasion by the tumor. Materials and MethodsMedical records of 27 patients with pyriform sinus cancer who underwent laryngopharyngectomy with ipsilateral hemithyroidectomy from 1999 to 2010 at a National Cancer Institute–designated comprehensive cancer center were retrospectively reviewed. Computed tomographic scans of the neck, operative notes, and surgical specimens were examined to determine the presence of thyroid gland invasion by imaging, clinical appearance, and pathology. ResultsThere were 19 male and 8 female patients (age range, 44-79 years; mean, 59.9 years). Most of the cases (85%) had advanced-stage disease. Extralaryngeal spread of tumor with thyroid cartilage invasion was noted in the computed tomographic scans of 5 patients; however, there was no radiologic evidence of thyroid gland invasion in any patient. No gross thyroid gland invasion by the tumor was appreciated in any patient during surgery. No histologic evidence of tumoral invasion of the thyroid gland was found in any of 27 surgical specimens. ConclusionsResults of this study suggest that thyroid gland invasion by pyriform sinus cancer is not common. Therefore, a routine ipsilateral hemithyroidectomy may not be necessary in the treatment of every patient with pyriform sinus cancer, unless there is evidence of thyroid gland invasion.